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A Journal on Vascular and Endovascular Surgery
Italian Journal of Vascular and Endovascular Surgery 2015 March;22(1):21-36
New developments in thoracic endovascular aortic repair
Brandt C. T., Sadie Ahanchi S., Panneton J. M.
Division of Vascular Surgery, Eastern Virginia Medical School, Norfolk, VA, USA
Thoracic endovascular aortic repair (TEVAR) has emerged as the preferred option for repair of a number of thoracic aortic pathologies. Currently, the accepted application of TEVAR includes high risk patients with thoracic aneurysms, penetrating ulcers and traumatic transection. TEVAR use has now been expanded to intramural hematomas, dissection, and exceedingly complex aortic arch and thoracoabdominal aneurysms. TEVAR, initially used in high risk patients and in emergent settings, is now applied prophylactically to prevent the progression of disease. Although perioperative morbidity and mortality are improved compared to open surgery, TEVAR is not without its drastic complications, including stroke, spinal cord ischemia and retrograde type A dissection. Patient selection is essential and certain anatomical constraints continue to prevent the universal application of endovascular repair. New techniques and technological developments continue to expand its use and improve long term durability. Although long term results of these adjuncts are not available at this time, mid-term results are encouraging, with comparable outcomes concerning aortic remodeling and branch patency. Currently available devices are evolving and useful adjuncts in both emergent and elective settings have been proven to be technically successful. The eventuality of total endovascular repair of the arch and thoracic aortic pathology, including the ascending aorta, relies on continued ingenuity and expertise of biomedical engineers and practicing surgeons.