Download PDF
Semin intervent Radiol 2015; 32(03): 265-271
DOI: 10.1055/s-0035-1558824
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

TEVAR: Endovascular Repair of the Thoracic Aorta

David A. Nation
1   Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania
,
Grace J. Wang
1   Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania
› Author Affiliations
Further Information

Publication History

Publication Date:
18 August 2015 (online)

Also available at
    Permissions and Reprints

Abstract

The development of thoracic endovascular aortic repair (TEVAR) has allowed a minimally invasive approach for management of an array of thoracic aortic pathologies. Initially developed specifically for exclusion of thoracic aortic aneurysms, TEVAR is now used as an alternative to open surgery for a variety of disease pathologies due to the lower morbidity of this approach. Advances in endograft technology continue to broaden the applications of this technique.

Keywords

thoracic endograft - thoracic aneurysm - vascular surgery - interventional radiology
 

  • References

  • 1 Makaroun MS, Dillavou ED, Kee ST , et al. Endovascular treatment of thoracic aortic aneurysms: results of the phase II multicenter trial of the GORE TAG thoracic endoprosthesis. J Vasc Surg 2005; 41 (1) 1-9
    CrossrefPubMedGoogle Scholar
  • 2 Bavaria JE, Appoo JJ, Makaroun MS, Verter J, Yu ZF, Mitchell RS ; Gore TAG Investigators. Endovascular stent grafting versus open surgical repair of descending thoracic aortic aneurysms in low-risk patients: a multicenter comparative trial. J Thorac Cardiovasc Surg 2007; 133 (2) 369-377
    CrossrefPubMedGoogle Scholar
  • 3 Matsumura JS, Cambria RP, Dake MD, Moore RD, Svensson LG, Snyder S ; TX2 Clinical Trial Investigators. International controlled clinical trial of thoracic endovascular aneurysm repair with the Zenith TX2 endovascular graft: 1-year results. J Vasc Surg 2008; 47 (2) 247-257 , discussion 257
    CrossrefPubMedGoogle Scholar
  • 4 Najibi S, Terramani TT, Weiss VJ , et al. Endoluminal versus open treatment of descending thoracic aortic aneurysms. J Vasc Surg 2002; 36 (4) 732-737
    CrossrefPubMedGoogle Scholar
  • 5 Stone DH, Brewster DC, Kwolek CJ , et al. Stent-graft versus open-surgical repair of the thoracic aorta: mid-term results. J Vasc Surg 2006; 44 (6) 1188-1197
    CrossrefPubMedGoogle Scholar
  • 6 Walsh SR, Tang TY, Sadat U , et al. Endovascular stenting versus open surgery for thoracic aortic disease: systematic review and meta-analysis of perioperative results. J Vasc Surg 2008; 47 (5) 1094-1098
    CrossrefPubMedGoogle Scholar
  • 7 Elefteriades JA. Indications for aortic replacement. J Thorac Cardiovasc Surg 2010; 140 (6, Suppl): S5-S9 , discussion S45–S51
    CrossrefPubMedGoogle Scholar
  • 8 Coady MA, Rizzo JA, Hammond GL, Kopf GS, Elefteriades JA. Surgical intervention criteria for thoracic aortic aneurysms: a study of growth rates and complications. Ann Thorac Surg 1999; 67 (6) 1922-1926 , discussion 1953–1958
    CrossrefPubMedGoogle Scholar
  • 9 Elefteriades JA. Natural history of thoracic aortic aneurysms: indications for surgery, and surgical versus nonsurgical risks. Ann Thorac Surg 2002; 74 (5) S1877-S1880 , discussion S1892–S1898
    CrossrefPubMedGoogle Scholar
  • 10 Svensson LG, Kouchoukos NT, Miller DC , et al; Society of Thoracic Surgeons Endovascular Surgery Task Force. Expert consensus document on the treatment of descending thoracic aortic disease using endovascular stent-grafts. Ann Thorac Surg 2008; 85 (1, Suppl): S1-S41
    CrossrefPubMedGoogle Scholar
  • 11 Demetriades D, Velmahos GC, Scalea TM , et al; American Association for the Surgery of Trauma Thoracic Aortic Injury Study Group. Operative repair or endovascular stent graft in blunt traumatic thoracic aortic injuries: results of an American Association for the Surgery of Trauma Multicenter Study. J Trauma 2008; 64 (3) 561-570 , discussion 570–571
    CrossrefPubMedGoogle Scholar
  • 12 Lee WA, Matsumura JS, Mitchell RS , et al. Endovascular repair of traumatic thoracic aortic injury: clinical practice guidelines of the Society for Vascular Surgery. J Vasc Surg 2011; 53 (1) 187-192
    CrossrefPubMedGoogle Scholar
  • 13 Demetriades D, Velmahos GC, Scalea TM , et al. Blunt traumatic thoracic aortic injuries: early or delayed repair—results of an American Association for the Surgery of Trauma prospective study. J Trauma 2009; 66 (4) 967-973
    CrossrefPubMedGoogle Scholar
  • 14 Garcia-Toca M, Naughton PA, Matsumura JS , et al. Endovascular repair of blunt traumatic thoracic aortic injuries: seven-year single-center experience. Arch Surg 2010; 145 (7) 679-683
    CrossrefPubMedGoogle Scholar
  • 15 Kaya A, Heijmen RH, Overtoom TT, Vos JA, Morshuis WJ, Schepens MA. Thoracic stent grafting for acute aortic pathology. Ann Thorac Surg 2006; 82 (2) 560-565
    CrossrefPubMedGoogle Scholar
  • 16 Duebener LF, Lorenzen P, Richardt G , et al. Emergency endovascular stent-grafting for life-threatening acute type B aortic dissections. Ann Thorac Surg 2004; 78 (4) 1261-1266 , discussion 1266–1267
    CrossrefPubMedGoogle Scholar
  • 17 Cronenwett J, Johnston KW. Rutherford's Vascular Surgery. 7th ed. Philadelphia, PA: Saunders Elsevier; 2010
    Google Scholar
  • 18 Nienaber CA, Eagle KA. Aortic dissection: new frontiers in diagnosis and management: Part II: therapeutic management and follow-up. Circulation 2003; 108 (6) 772-778
    CrossrefPubMedGoogle Scholar
  • 19 Estrera AL, Miller III CC, Safi HJ , et al. Outcomes of medical management of acute type B aortic dissection. Circulation 2006; 114 (1, Suppl): I384-I389
    CrossrefPubMedGoogle Scholar
  • 20 Nienaber CA, Zannetti S, Barbieri B, Kische S, Schareck W, Rehders TC ; INSTEAD Study Collaborators. INvestigation of STEnt grafts in patients with type B Aortic Dissection: design of the INSTEAD trial—a prospective, multicenter, European randomized trial. Am Heart J 2005; 149 (4) 592-599
    CrossrefPubMedGoogle Scholar
  • 21 Kwolek CJ, Watkins MT. The INvestigation of STEnt Grafts in Aortic Dissection (INSTEAD) trial: the need for ongoing analysis. Circulation 2009; 120 (25) 2513-2514
    CrossrefPubMedGoogle Scholar
  • 22 Nienaber CA, Kische S, Rousseau H , et al; INSTEAD-XL trial. Endovascular repair of type B aortic dissection: long-term results of the randomized investigation of stent grafts in aortic dissection trial. Circ Cardiovasc Interv 2013; 6 (4) 407-416
    CrossrefPubMedGoogle Scholar
  • 23 Brunkwall J, Kasprzak P, Verhoeven E , et al; ADSORB Trialists. Endovascular repair of acute uncomplicated aortic type B dissection promotes aortic remodelling: 1 year results of the ADSORB trial. Eur J Vasc Endovasc Surg 2014; 48 (3) 285-291
    CrossrefPubMedGoogle Scholar
  • 24 Conrad MF, Crawford RS, Kwolek CJ, Brewster DC, Brady TJ, Cambria RP. Aortic remodeling after endovascular repair of acute complicated type B aortic dissection. J Vasc Surg 2009; 50 (3) 510-517
    CrossrefPubMedGoogle Scholar
  • 25 Ganaha F, Miller DC, Sugimoto K , et al. Prognosis of aortic intramural hematoma with and without penetrating atherosclerotic ulcer: a clinical and radiological analysis. Circulation 2002; 106 (3) 342-348
    CrossrefPubMedGoogle Scholar
  • 26 Coady MA, Rizzo JA, Hammond GL, Pierce JG, Kopf GS, Elefteriades JA. Penetrating ulcer of the thoracic aorta: what is it? How do we recognize it? How do we manage it?. J Vasc Surg 1998; 27 (6) 1006-1015 , discussion 1015–1016
    CrossrefPubMedGoogle Scholar
  • 27 Shang EK, Nathan DP, Boonn WW , et al. A modern experience with saccular aortic aneurysms. J Vasc Surg 2013; 57 (1) 84-88
    CrossrefPubMedGoogle Scholar
  • 28 Black SA, Wolfe JH, Clark M, Hamady M, Cheshire NJ, Jenkins MP. Complex thoracoabdominal aortic aneurysms: endovascular exclusion with visceral revascularization. J Vasc Surg 2006; 43 (6) 1081-1089 , discussion 1089
    CrossrefPubMedGoogle Scholar
  • 29 Böckler D, Kotelis D, Geisbüsch P , et al. Hybrid procedures for thoracoabdominal aortic aneurysms and chronic aortic dissections - a single center experience in 28 patients. J Vasc Surg 2008; 47 (4) 724-732
    CrossrefPubMedGoogle Scholar
  • 30 Greenberg RK, Lytle B. Endovascular repair of thoracoabdominal aneurysms. Circulation 2008; 117 (17) 2288-2296
    CrossrefPubMedGoogle Scholar
  • 31 Canaud L, Ozdemir BA, Bee WW, Bahia S, Holt P, Thompson M. Thoracic endovascular aortic repair in management of aortoesophageal fistulas. J Vasc Surg 2014; 59 (1) 248-254
    CrossrefPubMedGoogle Scholar
  • 32 Vallabhajosyula P, Szeto WY, Desai N, Komlo C, Bavaria JE. Type II arch hybrid debranching procedure. Ann Cardiothorac Surg 2013; 2 (3) 378-386
    PubMedGoogle Scholar
  • 33 Ullery BW, Cheung AT, Fairman RM , et al. Risk factors, outcomes, and clinical manifestations of spinal cord ischemia following thoracic endovascular aortic repair. J Vasc Surg 2011; 54 (3) 677-684
    CrossrefPubMedGoogle Scholar
  • 34 van Bogerijen GHW, Williams DM, Eliason JL, Dasika NL, Deeb GM, Patel HJ. Alternative access techniques with thoracic endovascular aortic repair, open iliac conduit versus endoconduit technique. J Vasc Surg 2014; 60 (5) 1168-1176
    CrossrefPubMedGoogle Scholar
  • 35 Grobner T, Prischl FC. Patient characteristics and risk factors for nephrogenic systemic fibrosis following gadolinium exposure. Semin Dial 2008; 21 (2) 135-139
    CrossrefPubMedGoogle Scholar
  • 36 Szeto WY, Bavaria JE, Bowen FW, Woo EY, Fairman RM, Pochettino A. The hybrid total arch repair: brachiocephalic bypass and concomitant endovascular aortic arch stent graft placement. J Card Surg 2007; 22 (2) 97-102 , discussion 103–104
    CrossrefPubMedGoogle Scholar
  • 37 Zhou W, Reardon M, Peden EK, Lin PH, Lumsden AB. Hybrid approach to complex thoracic aortic aneurysms in high-risk patients: surgical challenges and clinical outcomes. J Vasc Surg 2006; 44 (4) 688-693
    CrossrefPubMedGoogle Scholar
  • 38 Bergeron P, Mangialardi N, Costa P , et al. Great vessel management for endovascular exclusion of aortic arch aneurysms and dissections. Eur J Vasc Endovasc Surg 2006; 32 (1) 38-45
    CrossrefPubMedGoogle Scholar
  • 39 Vaddineni SK, Taylor SM, Patterson MA, Jordan Jr WD. Outcome after celiac artery coverage during endovascular thoracic aortic aneurysm repair: preliminary results. J Vasc Surg 2007; 45 (3) 467-471
    CrossrefPubMedGoogle Scholar
  • 40 Gehringhoff B, Torsello G, Pitoulias GA, Austermann M, Donas KP. Use of chimney grafts in aortic arch pathologies involving the supra-aortic branches. J Endovasc Ther 2011; 18 (5) 650-655
    CrossrefPubMedGoogle Scholar
  • 41 Shahverdyan R, Gawenda M, Brunkwall J. Triple-barrel graft as a novel strategy to preserve supra-aortic branches in arch-TEVAR procedures: clinical study and systematic review. Eur J Vasc Endovasc Surg 2013; 45 (1) 28-35
    CrossrefPubMedGoogle Scholar
  • 42 Riesenman PJ, Farber MA, Mendes RR, Marston WA, Fulton JJ, Keagy BA. Coverage of the left subclavian artery during thoracic endovascular aortic repair. J Vasc Surg 2007; 45 (1) 90-94 , discussion 94–95
    CrossrefPubMedGoogle Scholar
  • 43 Matsumura JS, Lee WA, Mitchell RS , et al; Society for Vascular Surgery. The Society for Vascular Surgery Practice Guidelines: management of the left subclavian artery with thoracic endovascular aortic repair. J Vasc Surg 2009; 50 (5) 1155-1158
    CrossrefPubMedGoogle Scholar
  • 44 Jorna FH, Verhoeven EL, Bos WT, Prins TR, Dol JA, Reijnen MM. Treatment of a ruptured thoracoabdominal aneurysm with a stent-graft covering the celiac axis. J Endovasc Ther 2006; 13 (6) 770-774
    CrossrefPubMedGoogle Scholar
  • 45 Mehta M, Darling III RC, Taggert JB , et al. Outcomes of planned celiac artery coverage during TEVAR. J Vasc Surg 2010; 52 (5) 1153-1158
    CrossrefPubMedGoogle Scholar
  • 46 Lombardi JV, Cambria RP, Nienaber CA , et al; STABLE investigators. Prospective multicenter clinical trial (STABLE) on the endovascular treatment of complicated type B aortic dissection using a composite device design. J Vasc Surg 2012; 55 (3) 629-640.e2
    CrossrefPubMedGoogle Scholar
  • 47 Funovics M, Blum M, Langenberger H , et al. Endovascular repair of the descending aorta and the aortic arch with the Relay stent graft. Ann Thorac Surg 2009; 88 (2) 637-640
    CrossrefPubMedGoogle Scholar
  • 48 Cheung AT, Weiss SJ, McGarvey ML , et al. Interventions for reversing delayed-onset postoperative paraplegia after thoracic aortic reconstruction. Ann Thorac Surg 2002; 74 (2) 413-419 , discussion 420–421
    CrossrefPubMedGoogle Scholar
  • 49 Khoynezhad A, Donayre CE, Bui H, Kopchok GE, Walot I, White RA. Risk factors of neurologic deficit after thoracic aortic endografting. Ann Thorac Surg 2007; 83 (2) S882-S889 ; discussion S890–S892
    CrossrefPubMedGoogle Scholar
  • 50 Lee WA, Brown MP, Nelson PR, Huber TS. Total percutaneous access for endovascular aortic aneurysm repair (“Preclose” technique). J Vasc Surg 2007; 45 (6) 1095-1101
    CrossrefPubMedGoogle Scholar
  • 51 Nienaber CA, Kische S, Rehders TC , et al. Rapid pacing for better placing: comparison of techniques for precise deployment of endografts in the thoracic aorta. J Endovasc Ther 2007; 14 (4) 506-512
    CrossrefPubMedGoogle Scholar
  • 52 Piffaretti G, Mariscalco G, Tozzi M, Bruno VD, Sala A, Castelli P. Acute iatrogenic type A aortic dissection following thoracic aortic endografting. J Vasc Surg 2010; 51 (4) 993-999
    CrossrefPubMedGoogle Scholar
  • 53 Wang GJ, Jackson BM, Woo EY , et al. “Relining” of thoracic aortic stent grafts for patients presenting with rupture/impending rupture. Vasc Endovascular Surg 2011; 45 (5) 438-441
    CrossrefPubMedGoogle Scholar
  • 54 Gutsche JT, Cheung AT, McGarvey ML , et al. Risk factors for perioperative stroke after thoracic endovascular aortic repair. Ann Thorac Surg 2007; 84 (4) 1195-1200 , discussion 1200
    CrossrefPubMedGoogle Scholar
  • 55 Ullery BW, McGarvey M, Cheung AT , et al. Vascular distribution of stroke and its relationship to perioperative mortality and neurologic outcome after thoracic endovascular aortic repair. J Vasc Surg 2012; 56 (6) 1510-1517
    CrossrefPubMedGoogle Scholar
  • 56 Feezor RJ, Martin TD, Hess PJ , et al. Risk factors for perioperative stroke during thoracic endovascular aortic repairs (TEVAR). J Endovasc Ther 2007; 14 (4) 568-573
    CrossrefPubMedGoogle Scholar
  • 57 Woo EY, Mcgarvey M, Jackson BM, Bavaria JE, Fairman RM, Pochettino A. Spinal cord ischemia may be reduced via a novel technique of intercostal artery revascularization during open thoracoabdominal aneurysm repair. J Vasc Surg 2007; 46 (3) 421-426
    CrossrefPubMedGoogle Scholar
  • 58 Noor N, Sadat U, Hayes PD, Thompson MM, Boyle JR. Management of the left subclavian artery during endovascular repair of the thoracic aorta. J Endovasc Ther 2008; 15 (2) 168-176
    CrossrefPubMedGoogle Scholar
  • 59 Amabile P, Grisoli D, Giorgi R, Bartoli JM, Piquet P. Incidence and determinants of spinal cord ischaemia in stent-graft repair of the thoracic aorta. Eur J Vasc Endovasc Surg 2008; 35 (4) 455-461
    CrossrefPubMedGoogle Scholar
  • 60 Buth J, Harris PL, Hobo R , et al. Neurologic complications associated with endovascular repair of thoracic aortic pathology: Incidence and risk factors. a study from the European Collaborators on Stent/Graft Techniques for Aortic Aneurysm Repair (EUROSTAR) registry. J Vasc Surg 2007; 46 (6) 1103-1110 , discussion 1110–1111
    CrossrefPubMedGoogle Scholar
  • 61 Cheung AT, Pochettino A, McGarvey ML , et al. Strategies to manage paraplegia risk after endovascular stent repair of descending thoracic aortic aneurysms. Ann Thorac Surg 2005; 80 (4) 1280-1288 , discussion 1288–1289
    CrossrefPubMedGoogle Scholar
  • 62 Gabriel EA, Locali RF, Romano CC, Duarte AJ, Palma JH, Buffolo E. Analysis of the inflammatory response in endovascular treatment of aortic aneurysms. Eur J Cardiothorac Surg 2007; 31 (3) 406-412
    CrossrefPubMedGoogle Scholar
  • 63 Ishida M, Kato N, Hirano T, Shimono T, Shimpo H, Takeda K. Thoracic CT findings following endovascular stent-graft treatment for thoracic aortic aneurysm. J Endovasc Ther 2007; 14 (3) 333-341
    CrossrefPubMedGoogle Scholar
  • 64 Eggebrecht H, Mehta RH, Metozounve H , et al. Clinical implications of systemic inflammatory response syndrome following thoracic aortic stent-graft placement. J Endovasc Ther 2008; 15 (2) 135-143
    CrossrefPubMedGoogle Scholar
  • 65 Sakai T, Dake MD, Semba CP , et al. Descending thoracic aortic aneurysm: thoracic CT findings after endovascular stent-graft placement. Radiology 1999; 212 (1) 169-174
    CrossrefPubMedGoogle Scholar
  • 66 Schoder M, Cartes-Zumelzu F, Grabenwöger M , et al. Elective endovascular stent-graft repair of atherosclerotic thoracic aortic aneurysms: clinical results and midterm follow-up. AJR Am J Roentgenol 2003; 180 (3) 709-715
    CrossrefPubMedGoogle Scholar
  • 67 Makaroun MS, Dillavou ED, Wheatley GH, Cambria RP ; Gore TAG Investigators. Five-year results of endovascular treatment with the Gore TAG device compared with open repair of thoracic aortic aneurysms. J Vasc Surg 2008; 47 (5) 912-918
    CrossrefPubMedGoogle Scholar
  • 68 Sternbergh III WC, Money SR, Greenberg RK, Chuter TA ; Zenith Investigators. Influence of endograft oversizing on device migration, endoleak, aneurysm shrinkage, and aortic neck dilation: results from the Zenith Multicenter Trial. J Vasc Surg 2004; 39 (1) 20-26
    CrossrefPubMedGoogle Scholar
  • 69 Tadros RO, Lipsitz EC, Chaer RA, Faries PL, Marin ML, Cho JS. A multicenter experience of the management of collapsed thoracic endografts. J Vasc Surg 2011; 53 (5) 1217-1222
    CrossrefPubMedGoogle Scholar
  • 70 Preventza O, Wheatley III GH, Ramaiah VG , et al. Management of endoleaks associated with endovascular treatment of descending thoracic aortic diseases. J Vasc Surg 2008; 48 (1) 69-73
    CrossrefPubMedGoogle Scholar
  • 71 Demers P, Miller DC, Mitchell RS , et al. Midterm results of endovascular repair of descending thoracic aortic aneurysms with first-generation stent grafts. J Thorac Cardiovasc Surg 2004; 127 (3) 664-673
    CrossrefPubMedGoogle Scholar
  • 72 Svensson LG. Device discordancy: lost cords, quick-fix seekers, quality, and ethics. J Thorac Cardiovasc Surg 2006; 131 (2) 261-263
    CrossrefPubMedGoogle Scholar
  • 73 Dake MD, Miller DC, Mitchell RS, Semba CP, Moore KA, Sakai T. The “first generation” of endovascular stent-grafts for patients with aneurysms of the descending thoracic aorta. J Thorac Cardiovasc Surg 1998; 116 (5) 689-703 , discussion 703–704
    CrossrefPubMedGoogle Scholar