Endovascular Repair of Thoracic Aortic Aneurysms

Abstract Thoracic aortic aneurysms (TAAs) are potentially life-threatening and historically managed with open surgical repair. Thoracic endovascular aortic repair (TEVAR) offers a significantly less invasive method to exclude the aneurysm from systemic blood flow, thereby reducing the risks associated with the pre- and postoperative periods. Today, TEVAR is generally accepted as the first choice for most patients with degenerative descending TAAs, and it is being used increasingly for more complex aortic pathologies. Proper patient selection (anatomically suitable) is crucial, particularly for suitable landing zones and vascular access. Improvements in stent-graft design (flexible nitinol-based stents and branched/fenestrated configurations) have made the aortic arch and even the ascending aorta amenable for safe placement of a stent-graft. TEVAR offers improved survival rates, fewer complications, and shorter hospitalizations compared with open surgery. Nonetheless, there remain concerns regarding the long-term durability, particularly in younger patients who may require reinterventions. In addition to the complications typically seen with any form of endovascular repair (endoleaks, device migration, retrograde dissection, spinal cord ischemia), TEVAR also presents unique complications such as stroke. As with any form of endovascular repair, lifelong surveillance using computed tomography scans is required to monitor for late complications, determine the sac behavior of the aneurysm, etc. Regardless of the limitations presented by TEVAR, it has emerged as a major player in the treatment of TAAs. Ongoing refinements in stent-grafts, imaging modalities, and procedural techniques will continue to expand the applications of TEVAR and improve outcomes for an increasing number of patients with thoracic aortic diseases.