Download PDF
Int J Angiol 2018; 27(04): 177-184
DOI: 10.1055/s-0038-1666972
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Indications for Thoracic EndoVascular Aortic Repair (TEVAR): A Brief Review

Frank Manetta
1   Department of Cardiovascular and Thoracic Surgery, Northwell Health, Bay Shore, New York
2   Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra University, Hempstead, New York
,
Joshua Newman
2   Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra University, Hempstead, New York
,
Allan Mattia
1   Department of Cardiovascular and Thoracic Surgery, Northwell Health, Bay Shore, New York
2   Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra University, Hempstead, New York
› Author Affiliations
Further Information

Publication History

Publication Date:
02 August 2018 (online)

    Permissions and Reprints

Abstract

The utility of Thoracic EndoVascular Aortic Repair (TEVAR) continues to progress at a very rapid rate. Initially implemented for the treatment of thoracic aortic aneurysms, TEVAR has evolved to treat a variety of aortic pathologies and reduce overall morbidity and mortality rates compared with traditional open surgical repair.

Given the rapidly evolving nature of endovascular thoracic intervention, we hereby briefly review the current literature on the evolving applications of TEVAR.

TEVAR continues to rapidly evolve and is being applied to a growing number of aortic pathologies. Given the perioperative, short- and mid-term morbidity and mortality rates, TEVAR is quickly surpassing traditional open surgical intervention as the ideal procedure for patients undergoing intervention of the descending thoracic aorta and applicability to ascending and arch pathologies is being explored. However, as more data becomes available TEVAR may be associated with higher rates of reoperative requirements. Data remains limited on the long-term efficacy of the intervention and should continue to be investigated.

Keywords

aneurysm - aortic dissection - endograft placement - endovascular repair - TEVAR - pseudoaneurysm

Letter to this article:

Comment on: Indications for Thoracic Endovascular Aortic Repair (TEVAR): A Brief Review by Frank Manetta, MD, Joshua Newman, MS, Allan Mattia, MD. Int J Angiol 2018; 28:177–184Int J Angiol eFirst
DOI: 10.1055/s-0039-1679872

 

  • References

  • 1 Dake MD, Miller DC, Semba CP, Mitchell RS, Walker PJ, Liddell RP. Transluminal placement of endovascular stent-grafts for the treatment of descending thoracic aortic aneurysms. N Engl J Med 1994; 331 (26) 1729-1734 . Doi: 10.1056/NEJM199412293312601
    CrossrefPubMedGoogle Scholar
  • 2 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 (01) 1-9 . Doi: 10.1016/j.jvs.2004.10.046
    CrossrefPubMedGoogle Scholar
  • 3 Fillinger MF, Greenberg RK, McKinsey JF, Chaikof EL. ; Society for Vascular Surgery Ad Hoc Committee on TEVAR Reporting Standards. Reporting standards for thoracic endovascular aortic repair (TEVAR). J Vasc Surg 2010; 52 (04) 1022-1033 , 1033.e15
    CrossrefPubMedGoogle Scholar
  • 4 Hiratzka LF, Bakris GL, Beckman JA. , et al; American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines; American Association for Thoracic Surgery; American College of Radiology; American Stroke Association; Society of Cardiovascular Anesthesiologists; Society for Cardiovascular Angiography and Interventions; Society of Interventional Radiology; Society of Thoracic Surgeons; Society for Vascular Medicine. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation 2010; 121 (13) e266-e369 . Doi: 10.1161/CIR.0b013e3181d4739e
    PubMedGoogle Scholar
  • 5 Hughes GC, Daneshmand MA, Swaminathan M. , et al. “Real world” thoracic endografting: results with the Gore TAG device 2 years after U.S. FDA approval. Ann Thorac Surg 2008; 86 (05) 1530-1537 , discussion 1537–1538. Doi: 10.1016/j.athoracsur.2008.07.089
    CrossrefPubMedGoogle Scholar
  • 6 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 . Doi: 10.1016/j.athoracsur.2007.10.099
    CrossrefPubMedGoogle Scholar
  • 7 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 (02) 247-257 , discussion 257. Doi: 10.1016/j.jvs.2007.10.032
    CrossrefPubMedGoogle Scholar
  • 8 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 (05) 1094-1098 . Doi: 10.1016/j.jvs.2007.09.062
    CrossrefPubMedGoogle Scholar
  • 9 Abraha I, Romagnoli C, Montedori A, Cirocchi R. Thoracic stent graft versus surgery for thoracic aneurysm. Cochrane Database Syst Rev 2013; CD006796 (09) CD006796 . Doi: 10.1002/14651858.CD006796.pub3
    PubMedGoogle Scholar
  • 10 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 (03) 664-673 . Doi: 10.1016/j.jtcvs.2003.10.047
    CrossrefPubMedGoogle Scholar
  • 11 Fairman RM, Criado F, Farber M. , et al; VALOR Investigators. Pivotal results of the Medtronic Vascular Talent Thoracic Stent Graft System: the VALOR trial. J Vasc Surg 2008; 48 (03) 546-554 . Doi: 10.1016/j.jvs.2008.03.061
    CrossrefPubMedGoogle Scholar
  • 12 Maldonado TS, Dexter D, Rockman CB. , et al. Left subclavian artery coverage during thoracic endovascular aortic aneurysm repair does not mandate revascularization. J Vasc Surg 2013; 57 (01) 116-124 . Doi: 10.1016/j.jvs.2012.06.101
    CrossrefPubMedGoogle Scholar
  • 13 von Allmen RS, Gahl B, Powell JT. Editor's Choice - Incidence of Stroke Following Thoracic Endovascular Aortic Repair for Descending Aortic Aneurysm: A Systematic Review of the Literature with Meta-analysis. Eur J Vasc Endovasc Surg 2017; 53 (02) 176-184 . Doi: 10.1016/j.ejvs.2016.10.025
    CrossrefPubMedGoogle Scholar
  • 14 Huang YK, Ko PJ, Chen CL. , et al. Therapeutic opinion on endovascular repair for mycotic aortic aneurysm. Ann Vasc Surg 2014; 28 (03) 579-589 . Doi: 10.1016/j.avsg.2013.07.009
    CrossrefPubMedGoogle Scholar
  • 15 Kan CD, Lee HL, Yang YJ. Outcome after endovascular stent graft treatment for mycotic aortic aneurysm: a systematic review. J Vasc Surg 2007; 46 (05) 906-912 . Doi: 10.1016/j.jvs.2007.07.025
    CrossrefPubMedGoogle Scholar
  • 16 Stanson AW, Kazmier FJ, Hollier LH. , et al. Penetrating atherosclerotic ulcers of the thoracic aorta: natural history and clinicopathologic correlations. Ann Vasc Surg 1986; 1 (01) 15-23 . Doi: 10.1016/S0890-5096(06)60697-3
    CrossrefPubMedGoogle Scholar
  • 17 Nathan DP, Boonn W, Lai E. , et al. Presentation, complications, and natural history of penetrating atherosclerotic ulcer disease. J Vasc Surg 2012; 55 (01) 10-15 . Doi: 10.1016/j.jvs.2011.08.005
    CrossrefPubMedGoogle Scholar
  • 18 Tittle SL, Lynch RJ, Cole PE. , et al. Midterm follow-up of penetrating ulcer and intramural hematoma of the aorta. J Thorac Cardiovasc Surg 2002; 123 (06) 1051-1059
    CrossrefPubMedGoogle Scholar
  • 19 Harris KM, Braverman AC, Eagle KA. , et al. Acute aortic intramural hematoma: an analysis from the International Registry of Acute Aortic Dissection. Circulation 2012; 126 (11) (Suppl. 01) S91-S96 . Doi: 10.1161/CIRCULATIONAHA.111.084541
    CrossrefPubMedGoogle Scholar
  • 20 Grabenwöger M, Alfonso F, Bachet J. , et al; European Association for Cardio-Thoracic Surgery (EACTS); European Society of Cardiology (ESC); European Association of Percutaneous Cardiovascular Interventions (EAPCI). Thoracic Endovascular Aortic Repair (TEVAR) for the treatment of aortic diseases: a position statement from the European Association for Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur J Cardiothorac Surg 2012; 42 (01) 17-24 . Doi: 10.1093/ejcts/ezs107
    CrossrefPubMedGoogle Scholar
  • 21 Cho KR, Stanson AW, Potter DD, Cherry KJ, Schaff HV, Sundt III TM. Penetrating atherosclerotic ulcer of the descending thoracic aorta and arch. J Thorac Cardiovasc Surg 2004; 127 (05) 1393-1399 , discussion 1399–1401. Doi: 10.1016/j.jtcvs.2003.11.050
    CrossrefPubMedGoogle Scholar
  • 22 Eggebrecht H, Plicht B, Kahlert P, Erbel R. Intramural hematoma and penetrating ulcers: indications to endovascular treatment. Eur J Vasc Endovasc Surg 2009; 38 (06) 659-665 . Doi: 10.1016/j.ejvs.2009.09.001
    CrossrefPubMedGoogle Scholar
  • 23 Cho JS, Haider SE, Makaroun MS. US multicenter trials of endoprostheses for the endovascular treatment of descending thoracic aneurysms. J Vasc Surg 2006; 43 (Suppl A): 12A-19A
    CrossrefPubMedGoogle Scholar
  • 24 Atik FA, Navia JL, Svensson LG. , et al. Surgical treatment of pseudoaneurysm of the thoracic aorta. J Thorac Cardiovasc Surg 2006; 132 (02) 379-385 . Doi: 10.1016/j.jtcvs.2006.03.052
    CrossrefPubMedGoogle Scholar
  • 25 Neschis DG, Scalea TM, Flinn WR, Griffith BP. Blunt aortic injury. N Engl J Med 2008; 359 (16) 1708-1716 . Doi: 10.1056/NEJMra0706159
    CrossrefPubMedGoogle Scholar
  • 26 Sevitt S. The mechanisms of traumatic rupture of the thoracic aorta. Br J Surg 1977; 64 (03) 166-173
    CrossrefPubMedGoogle Scholar
  • 27 Gandhi SS, Blas JV, Lee S, Eidt JF, Carsten III CG. Nonoperative management of grade III blunt thoracic aortic injuries. J Vasc Surg 2016; 64 (06) 1580-1586 . Doi: 10.1016/j.jvs.2016.05.070
    CrossrefPubMedGoogle Scholar
  • 28 Steinberg ZL, Don CW, Sun JC, Gill Jr EA, Goldberg SL. Percutaneous Repair of Aortic Pseudoaneurysms: A Case Series. J Invasive Cardiol 2016; 28 (01) E6-E10
    PubMedGoogle Scholar
  • 29 Pirelli L, Kliger C, Fontana GP, Ruiz CE. Direct percutaneous transaortic approach for treatment of aortic pseudoaneurysms. Interact Cardiovasc Thorac Surg 2015; 20 (05) 680-681 . Doi: 10.1093/icvts/ivv027
    CrossrefPubMedGoogle Scholar
  • 30 Alfson DB, Ham SW, Type B. Type B Aortic Dissections: Current Guidelines for Treatment. Cardiol Clin 2017; 35 (03) 387-410 . Doi: 10.1016/j.ccl.2017.03.007
    PubMedGoogle Scholar
  • 31 Fleerakkers J, Schepens M. How should we manage dissections type B aortic?. Gen Thorac Cardiovasc Surg 2017; ••• DOI: 10.1007/s11748-017-0818-5.
    CrossrefPubMedGoogle Scholar
  • 32 Kodama K, Nishigami K, Sakamoto T. , et al. Tight heart rate control reduces secondary adverse events in patients with type B acute aortic dissection. Circulation 2008; 118 (14, Suppl) S167-S170 . Doi: 10.1161/CIRCULATIONAHA.107.755801
    CrossrefPubMedGoogle Scholar
  • 33 Andersen ND, Keenan JE, Ganapathi AM, Gaca JG, McCann RL, Hughes GC. Current management and outcome of chronic type B aortic dissection: results with open and endovascular repair since the advent of thoracic endografting. Ann Cardiothorac Surg 2014; 3 (03) 264-274 . Doi: 10.3978/j.issn.2225-319X.2014.05.07
    PubMedGoogle Scholar
  • 34 Khoynezhad A, Toluie S, Al-Atassi T. Treatment of the Chronic Type B Aortic Dissection: The Pro-endovascular Argument. Semin Thorac Cardiovasc Surg 2017; 29 (02) 131-136 . Doi: 10.1053/j.semtcvs.2017.03.001
    CrossrefPubMedGoogle Scholar
  • 35 Parsa CJ, Schroder JN, Daneshmand MA, McCann RL, Hughes GC. Midterm results for endovascular repair of complicated acute and chronic type B aortic dissection. Ann Thorac Surg 2010; 89 (01) 97-102 , discussion 102–104. Doi: 10.1016/j.athoracsur.2009.09.029
    CrossrefPubMedGoogle Scholar
  • 36 Dake MD, Kato N, Mitchell RS. , et al. Endovascular stent-graft placement for the treatment of acute aortic dissection. N Engl J Med 1999; 340 (20) 1546-1552 . Doi: 10.1056/NEJM199905203402004
    CrossrefPubMedGoogle Scholar
  • 37 Nauta FJ, Trimarchi S, Kamman AV. , et al. Update in the management of type B aortic dissection. Vasc Med 2016; 21 (03) 251-263 . Doi: 10.1177/1358863 × 16642318
    CrossrefPubMedGoogle Scholar
  • 38 Patterson B, Holt P, Nienaber C, Cambria R, Fairman R, Thompson M. Aortic pathology determines midterm outcome after endovascular repair of the thoracic aorta: report from the Medtronic Thoracic Endovascular Registry (MOTHER) database. Circulation 2013; 127 (01) 24-32 . Doi: 10.1161/CIRCULATIONAHA.112.110056
    CrossrefPubMedGoogle Scholar
  • 39 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 (04) 407-416 . Doi: 10.1161/CIRCINTERVENTIONS.113.000463
    CrossrefPubMedGoogle Scholar
  • 40 Ray HM, Durham CA, Ocazionez D. , et al. Predictors of intervention and mortality in patients with uncomplicated acute type B aortic dissection. J Vasc Surg 2016; 64 (06) 1560-1568 . Doi: 10.1016/j.jvs.2016.07.111
    CrossrefPubMedGoogle Scholar
  • 41 Zeeshan A, Woo EY, Bavaria JE. , et al. Thoracic endovascular aortic repair for acute complicated type B aortic dissection: superiority relative to conventional open surgical and medical therapy. J Thorac Cardiovasc Surg 2010; 140 (6, Suppl) S109-S115 , discussion S142–S146
    CrossrefPubMedGoogle Scholar
  • 42 Trimarchi S, Nienaber CA, Rampoldi V. , et al; IRAD Investigators. Role and results of surgery in acute type B aortic dissection: insights from the International Registry of Acute Aortic Dissection (IRAD). Circulation 2006; 114 (1, Suppl) I357-I364 . Doi: 10.1161/CIRCULATIONAHA.105.000620
    PubMedGoogle Scholar
  • 43 Virtue Registry I. ; Virtue Registry Investigators. The VIRTUE Registry of type B thoracic dissections–study design and early results. Eur J Vasc Endovasc Surg 2011; 41 (02) 159-166 . Doi: 10.1016/j.ejvs.2010.08.016
    CrossrefPubMedGoogle Scholar
  • 44 Kang WC, Greenberg RK, Mastracci TM. , et al. Endovascular repair of complicated chronic distal aortic dissections: intermediate outcomes and complications. J Thorac Cardiovasc Surg 2011; 142 (05) 1074-1083 . Doi: 10.1016/j.jtcvs.2011.03.008
    CrossrefPubMedGoogle Scholar
  • 45 Lombardi JV, Cambria RP, Nienaber CA. , et al; STABLE investigators. Aortic remodeling after endovascular treatment of complicated type B aortic dissection with the use of a composite device design. J Vasc Surg 2014; 59 (06) 1544-1554 . Doi: 10.1016/j.jvs.2013.12.038
    CrossrefPubMedGoogle Scholar
  • 46 Steuer J, Björck M, Mayer D, Wanhainen A, Pfammatter T, Lachat M. Distinction between acute and chronic type B aortic dissection: is there a sub-acute phase?. Eur J Vasc Endovasc Surg 2013; 45 (06) 627-631 . Doi: 10.1016/j.ejvs.2013.03.013
    CrossrefPubMedGoogle Scholar
  • 47 Clancy TV, Gary Maxwell J, Covington DL, Brinker CC, Blackman D. A statewide analysis of level I and II trauma centers for patients with major injuries. J Trauma 2001; 51 (02) 346-351
    CrossrefPubMedGoogle Scholar
  • 48 Cowley RA, Turney SZ, Hankins JR, Rodriguez A, Attar S, Shankar BS. Rupture of thoracic aorta caused by blunt trauma. A fifteen-year experience. J Thorac Cardiovasc Surg 1990; 100 (05) 652-660 , discussion 660–661
    CrossrefPubMedGoogle Scholar
  • 49 Xenos ES, Abedi NN, Davenport DL. , et al. Meta-analysis of endovascular vs open repair for traumatic descending thoracic aortic rupture. J Vasc Surg 2008; 48 (05) 1343-1351 . Doi: 10.1016/j.jvs.2008.04.060
    CrossrefPubMedGoogle Scholar
  • 50 Hoffer EK, Forauer AR, Silas AM, Gemery JM. Endovascular stent-graft or open surgical repair for blunt thoracic aortic trauma: systematic review. J Vasc Interv Radiol 2008; 19 (08) 1153-1164 . Doi: 10.1016/j.jvir.2008.05.012
    CrossrefPubMedGoogle Scholar
  • 51 Arthurs ZM, Starnes BW, Sohn VY, Singh N, Martin MJ, Andersen CA. Functional and survival outcomes in traumatic blunt thoracic aortic injuries: An analysis of the National Trauma Databank. J Vasc Surg 2009; 49 (04) 988-994 . Doi: 10.1016/j.jvs.2008.11.052
    CrossrefPubMedGoogle Scholar
  • 52 Cardarelli MG, McLaughlin JS, Downing SW, Brown JM, Attar S, Griffith BP. Management of traumatic aortic rupture: a 30-year experience. Ann Surg 2002; 236 (04) 465-469 , discussion 469–470. Doi: 10.1097/01.SLA.0000028968.68441.A5
    CrossrefPubMedGoogle Scholar
  • 53 Pate JW, Fabian TC, Walker W. Traumatic rupture of the aortic isthmus: an emergency?. World J Surg 1995; 19 (01) 119-125 , discussion 125–126
    CrossrefPubMedGoogle Scholar
  • 54 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 (01) 187-192 . Doi: 10.1016/j.jvs.2010.08.027
    CrossrefPubMedGoogle Scholar
  • 55 Tehrani HY, Peterson BG, Katariya K. , et al. Endovascular repair of thoracic aortic tears. Ann Thorac Surg 2006; 82 (03) 873-877 , discussion 877–878. Doi: 10.1016/j.athoracsur.2006.04.012
    CrossrefPubMedGoogle Scholar
  • 56 Tang GL, Tehrani HY, Usman A. , et al. Reduced mortality, paraplegia, and stroke with stent graft repair of blunt aortic transections: a modern meta-analysis. J Vasc Surg 2008; 47 (03) 671-675 . Doi: 10.1016/j.jvs.2007.08.031
    CrossrefPubMedGoogle Scholar
  • 57 Szostek M, Jakuczun W, Oseka M. , et al. Endovascular treatment of traumatic rupture of thoracic aorta: long term results. Int Angiol 2016; 35 (02) 129-139
    PubMedGoogle Scholar
  • 58 Carter R, Mulder GA, Snyder Jr EN, Brewer III LA. Aortoesophageal fistula. Am J Surg 1978; 136 (01) 26-30
    CrossrefPubMedGoogle Scholar
  • 59 Dorweiler B, Weigang E, Duenschede F, Pitton MB, Dueber C, Vahl CF. Strategies for endovascular aortic repair in aortobronchial and aortoesophageal fistulas. Thorac Cardiovasc Surg 2013; 61 (07) 575-580 . Doi: 10.1055/s-0033-1347294
    Article in Thieme ConnectPubMedGoogle Scholar
  • 60 Jonker FH, Heijmen R, Trimarchi S, Verhagen HJ, Moll FL, Muhs BE. Acute management of aortobronchial and aortoesophageal fistulas using thoracic endovascular aortic repair. J Vasc Surg 2009; 50 (05) 999-1004 . Doi: 10.1016/j.jvs.2009.04.043
    CrossrefPubMedGoogle Scholar
  • 61 Chiesa R, Kahlberg A, Tshomba Y, Marone EM, Marrocco-Trischitta MM, Melissano G. Endovascular repair of aortoesophageal and aortobronchial fistulae. Tex Heart Inst J 2011; 38 (06) 655-657
    PubMedGoogle Scholar
  • 62 Kahlberg A, Tshomba Y, Marone EM, Castellano R, Melissano G, Chiesa R. Current results of a combined endovascular and open approach for the treatment of aortoesophageal and aortobronchial fistulae. Ann Vasc Surg 2014; 28 (07) 1782-1788 . Doi: 10.1016/j.avsg.2014.06.003
    CrossrefPubMedGoogle Scholar
  • 63 Canaud L, D'Annoville T, Ozdemir BA, Marty-Ané C, Alric P. Combined endovascular and surgical approach for aortobronchial fistula. J Thorac Cardiovasc Surg 2014; 148 (05) 2108-2111 . Doi: 10.1016/j.jtcvs.2014.01.018
    CrossrefPubMedGoogle Scholar