Prophylactic thoracic endovascular aortic repair (p-TEVAR) before radiotherapy in advanced non-small cell lung cancer: a technical note and case series

Abstract Advanced non-small cell lung cancer (NSCLC) with thoracic aortic invasion (T4Ao) is a life-threatening condition and represents a major therapeutic challenge. Radiotherapy (RT) is often recommended for local control or palliation; however, it carries a substantial risk of vascular complications, including aortic rupture, thrombosis and pseudoaneurysm formation. Thoracic endovascular aortic repair (TEVAR) provides mechanical reinforcement of the aortic wall, potentially mitigating these risks and enabling safer administration of high-dose RT. This technical note describes our experience with prophylactic TEVAR (p-TEVAR) performed prior to RT. Three patients with cT4Ao-NSCLC completed the procedure and subsequent treatment without procedure-related vascular complications, achieving partial tumor response in two patients. Follow-up ranged from 6 to 10 months after radiotherapy, with no evidence of endoleak, graft migration, thrombosis, pseudoaneurysm, or aortic rupture. p-TEVAR may represent a feasible adjunct to radiotherapy or chemoradiotherapy in selected patients with advanced thoracic malignancies involving the aorta. This study highlights the feasibility of endovascular reinforcement and the importance of multidisciplinary decision-making.