Semin intervent Radiol 2009; 26(1): 017-024
DOI: 10.1055/s-0029-1208379
© Thieme Medical Publishers

Endovascular Repair of the Thoracic Aorta

Grace J. Wang1 , Ronald M. Fairman1
  • 1Division of Vascular Surgery and Endovascular Therapy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
Further Information

Publication History

Publication Date:
16 March 2009 (online)


The emergence of endovascular repair of the thoracic aorta (TEVAR) quickly followed the development of technology for the exclusion of infrarenal abdominal aortic aneurysms. Stent grafts comprised of metal struts covered with fabric made of Dacron/polyester or polytetrafluoroethylene were developed for the purpose of achieving an adequate seal at the proximal and distal aspects of thoracic aneurysms, thus excluding sac flow. The recognition of the decreased morbidity of this approach compared with open repair was readily apparent, as it avoided left thoracotomy, aortic cross-clamping, and left heart bypass. Since then, TEVAR is increasingly being used for other aortic pathologies such as complicated type B dissection, traumatic aortic transection, and aneurysmal disease extending into the arch or visceral segment, requiring debranching procedures.


  • 1 Makaroun M S, Dillavou E D, Kee S T 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 1-9
  • 2 Bavaria J E, Appoo J J, Makaroun M S, Verter J, Yu Z F, Mitchell R S. 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;  133 369-377
  • 3 Matsumura J S, Cambria R P, Dake M D, Moore R D, Svensson L G, Snyder S. International controlled clinical trial of thoracic endovascular aneurysm repair with the Zenith TX2 endovascular graft: 1-year results.  J Vasc Surg. 2008;  47 247-257 discussion 257
  • 4 Najibi S, Terramani T T, Weiss V J et al.. Endoluminal versus open treatment of descending thoracic aortic aneurysms.  J Vasc Surg. 2002;  36 732-737
  • 5 Stone D H, Brewster D C, Kwolek C J et al.. Stent-graft versus open-surgical repair of the thoracic aorta: mid-term results.  J Vasc Surg. 2006;  44 1188-1197
  • 6 Demetriades D, Velmahos G C, Scalea T M et al.. 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;  64 561-570 discussion 570-571
  • 7 Nienaber C A, Zannetti S, Barbieri B, Kische S, Schareck W, Rehders T C. 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;  149 592-599
  • 8 Kaya A, Heijmen R H, Overtoom T T, Vos J A, Morshuis W J, Schepens M A. Thoracic stent grafting for acute aortic pathology.  Ann Thorac Surg. 2006;  82 560-565
  • 9 Duebener L F, Lorenzen P, Richardt G et al.. Emergency endovascular stent-grafting for life-threatening acute type B aortic dissections.  Ann Thorac Surg. 2004;  78 1261-1266 discussion 1266-1267
  • 10 Black S A, Wolfe J H, Clark M, Hamady M, Cheshire N J, Jenkins M P. Complex thoracoabdominal aortic aneurysms: endovascular exclusion with visceral revascularization.  J Vasc Surg. 2006;  43 1081-1089 discussion 1089
  • 11 Bockler D, Kotelis D, Geisbusch P et al.. Hybrid procedures for thoracoabdominal aortic aneurysms and chronic aortic dissections: a single center experience in 28 patients.  J Vasc Surg. 2008;  47 724-732
  • 12 Greenberg R K, Lytle B. Endovascular repair of thoracoabdominal aneurysms.  Circulation. 2008;  117 2288-2296
  • 13 Szeto W Y, Bavaria J E, Bowen F W, Woo E Y, Fairman R M, Pochettino A. The hybrid total arch repair: brachiocephalic bypass and concomitant endovascular aortic arch stent graft placement.  J Card Surg. 2007;  22 97-102 discussion 103-104
  • 14 Zhou W, Reardon M, Peden E K, Lin P H, Lumsden A B. Hybrid approach to complex thoracic aortic aneurysms in high-risk patients: surgical challenges and clinical outcomes.  J Vasc Surg. 2006;  44 688-693
  • 15 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 38-45
  • 16 Chuter T A, Schneider D B, Reilly L M, Lobo E P, Messina L M. Modular branched stent graft for endovascular repair of aortic arch aneurysm and dissection.  J Vasc Surg. 2003;  38 859-863
  • 17 Vaddineni S K, Taylor S M, Patterson M A, Jordan Jr W D. Outcome after celiac artery coverage during endovascular thoracic aortic aneurysm repair: preliminary results.  J Vasc Surg. 2007;  45 467-471
  • 18 Jorna F H, Verhoeven E L, Bos W T, Prins T R, Dol J A, Reijnen M M. Treatment of a ruptured thoracoabdominal aneurysm with a stent-graft covering the celiac axis.  J Endovasc Ther. 2006;  13 770-774
  • 19 Grobner T, Prischl F C. Patient characteristics and risk factors for nephrogenic systemic fibrosis following gadolinium exposure.  Semin Dial. 2008;  21 135-139
  • 20 Lin P H, El Sayed H F, Kougias P, Zhou W, LeMaire S A, Coselli J S. Endovascular repair of thoracic aortic disease: overview of current devices and clinical results.  Vascular. 2007;  15 179-190
  • 21 Cheung A T, Weiss S J, McGarvey M L et al.. Interventions for reversing delayed-onset postoperative paraplegia after thoracic aortic reconstruction.  Ann Thorac Surg. 2002;  74 413-419 discussion 420-421
  • 22 Khoynezhad A, Donayre C E, Bui H, Kopchok G E, Walot I, White R A. Risk factors of neurologic deficit after thoracic aortic endografting.  Ann Thorac Surg. 2007;  83 S882-S889 discussion S890-S892
  • 23 Nienaber C A, Kische S, Rehders T C et al.. Rapid pacing for better placing: comparison of techniques for precise deployment of endografts in the thoracic aorta.  J Endovasc Ther. 2007;  14 506-512
  • 24 Gutsche J T, Cheung A T, McGarvey M L et al.. Risk factors for perioperative stroke after thoracic endovascular aortic repair.  Ann Thorac Surg. 2007;  84 1195-1200 discussion 1200
  • 25 Feezor R J, Martin T D, Hess P J et al.. Risk factors for perioperative stroke during thoracic endovascular aortic repairs (TEVAR).  J Endovasc Ther. 2007;  14 568-573
  • 26 Woo E Y, McGarvey M, Jackson B M, Bavaria J E, Fairman R M, 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;  46 421-426
  • 27 Noor N, Sadat U, Hayes P D, Thompson M M, Boyle J R. Management of the left subclavian artery during endovascular repair of the thoracic aorta.  J Endovasc Ther. 2008;  15 168-176
  • 28 Riesenman P J, Farber M A, Mendes R R, Marston W A, Fulton J J, Keagy B A. Coverage of the left subclavian artery during thoracic endovascular aortic repair.  J Vasc Surg. 2007;  45 90-94 discussion 94-95
  • 29 Amabile P, Grisoli D, Giorgi R, Bartoli J M, Piquet P. Incidence and determinants of spinal cord ischaemia in stent-graft repair of the thoracic aorta.  Eur J Vasc Endovasc Surg. 2008;  35 455-461
  • 30 Buth J, Harris P L, 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 1103-1110 discussion 1110-1111
  • 31 Cheung A T, Pochettino A, McGarvey M L et al.. Strategies to manage paraplegia risk after endovascular stent repair of descending thoracic aortic aneurysms.  Ann Thorac Surg. 2005;  80 1280-1288 discussion 1288-1289
  • 32 Gabriel E A, Locali R F, Romano C C, Duarte A J, Palma J H, Buffolo E. Analysis of the inflammatory response in endovascular treatment of aortic aneurysms.  Eur J Cardiothorac Surg. 2007;  31 406-412
  • 33 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;  14 333-341
  • 34 Eggebrecht H, Mehta R H, Metozounve H et al.. Clinical implications of systemic inflammatory response syndrome following thoracic aortic stent-graft placement.  J Endovasc Ther. 2008;  15 135-143
  • 35 Sakai T, Dake M D, Semba C P et al.. Descending thoracic aortic aneurysm: thoracic CT findings after endovascular stent-graft placement.  Radiology. 1999;  212 169-174
  • 36 Schoder M, Cartes-Zumelzu F, Grabenwoger M et al.. Elective endovascular stent-graft repair of atherosclerotic thoracic aortic aneurysms: clinical results and midterm follow-up.  AJR Am J Roentgenol. 2003;  180 709-715
  • 37 Makaroun M S, Dillavou E D, Wheatley G H, Cambria R P. Five-year results of endovascular treatment with the Gore TAG device compared with open repair of thoracic aortic aneurysms.  J Vasc Surg. 2008;  47 912-918
  • 38 Preventza O, Wheatley III G H, Ramaiah V G et al.. Management of endoleaks associated with endovascular treatment of descending thoracic aortic diseases.  J Vasc Surg. 2008;  48 69-73
  • 39 Demers P, Miller D C, Mitchell R S et al.. Midterm results of endovascular repair of descending thoracic aortic aneurysms with first-generation stent grafts.  J Thorac Cardiovasc Surg. 2004;  127 664-673
  • 40 Svensson L G. Device discordancy: lost cords, quick-fix seekers, quality, and ethics.  J Thorac Cardiovasc Surg. 2006;  131 261-263
  • 41 Dake M D, Miller D C, Mitchell R S, Semba C P, Moore K A, Sakai T. The “first generation” of endovascular stent-grafts for patients with aneurysms of the descending thoracic aorta.  J Thorac Cardiovasc Surg. 1998;  116 689-703 discussion 703-704

Grace WangM.D. 

Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, Hospital of the University of Pennsylvania

3400 Spruce Street, 4 Silverstein Pavilion, Philadelphia, PA 19104