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CC BY 4.0 · Aorta (Stamford) 2020; 08(03): 049-058
DOI: 10.1055/s-0040-1714089
State-of-the-Art Review

Complications and Management of the Thoracic Endovascular Aortic Repair

Sheena W. Chen
1   George Washington University Hospital, Washington, District of Columbia
,
Kyongjune B. Lee
1   George Washington University Hospital, Washington, District of Columbia
,
Michael A. Napolitano
1   George Washington University Hospital, Washington, District of Columbia
,
Alejandro E. Murillo-Berlioz
1   George Washington University Hospital, Washington, District of Columbia
,
Anna P. Sattah
2   Holy Cross Hospital, Silver Spring, Maryland
,
Shawn Sarin
1   George Washington University Hospital, Washington, District of Columbia
,
Gregory Trachiotis
1   George Washington University Hospital, Washington, District of Columbia
› Author Affiliations Funding None.
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Abstract

Endovascular treatment in thoracic aortic diseases has increased in use exponentially since Dake and colleagues first described the use of a home-made transluminal endovascular graft on 13 patients with descending thoracic aortic aneurysm at Stanford University in the early 1990s. Thoracic endovascular aneurysm repair (TEVAR) was initially developed for therapy in patients deemed unfit for open surgery. Innovations in endograft engineering design and popularization of endovascular techniques have transformed TEVAR to the predominant treatment choice in elective thoracic aortic repair. The number of TEVARs performed in the United States increased by 600% from 1998 to 2007, while the total number of thoracic aortic repairs increased by 60%. As larger multicenter trials and meta-analysis studies in the 2000s demonstrate the significant decrease in perioperative morbidity and mortality of TEVAR over open repair, TEVAR became incorporated into standard guidelines. The 2010 American consensus guidelines recommend TEVAR to be “strongly considered” when feasible for patients with degenerative or traumatic aneurysms of the descending thoracic aorta exceeding 5.5 cm, saccular aneurysms, or postoperative pseudoaneurysms. Nowadays, TEVAR is the predominant treatment for degenerative and traumatic descending thoracic aortic aneurysm repair. Although TEVAR has been shown to have decreased early morbidity and mortality compared with open surgical repair, endovascular manipulation of a diseased aorta with endovascular devices continues to have significant risks. Despite continued advancement in endovascular technique and devices since the first prospective trial examined the complications associated with TEVAR, common complications, two decades later, still include stroke, spinal cord ischemia, device failure, unintentional great vessel coverage, access site complications, and renal injury. In this article, we review common TEVAR complications with some corresponding radiographic imaging and their management.

Keywords

thoracic aorta endovascular repair - endovascular - aortic disease - thoracic aorta - complications - management - stent graft


Publication History

Received: 14 January 2019

Accepted: 24 May 2020

Article published online:
05 November 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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