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Endovascular Stent Grafts for Disorders of the Thoracic Aorta

Endovascular stent grafts using devices approved by U.S. Food and Drug Administration (FDA) may be considered medically necessary for the following conditions:
Descending thoracic aortic aneurysms used according to FDA-approved specifications (see Policy Guidelines section).

Acute, complicated (organ or limb ischemia or rupture) type B thoracic aortic dissection.

Traumatic descending aortic tears or rupture.

Endovascular stent grafts are considered investigational for the treatment of descending aortic disorders that do not meet the above criteria, including but not limited to uncomplicated aortic dissection.

Endovascular stent grafts are considered investigational for the treatment of ascending aortic disorders, including but not limited to thoracic aortic arch aneurysms.

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