Endovascular Thoracic Stent-Grafting: Procedure, Benefits, and Indications

Thoracic endovascular aortic repair (TEVAR) is a minimally invasive alternative to open thoracotomy for descending thoracic aortic pathology.

Procedure Steps

1. Access: Percutaneous or surgical cutdown of common femoral artery.
2. Deployment: Stent-graft (fabric-covered metal frame) advanced under fluoroscopic guidance to cover lesion.
3. Expansion: Balloon-expandable or self-expanding; seals against healthy aorta proximal/distal to pathology.
4. Completion angiography: Confirms exclusion, patency of branch vessels, no endoleak.
5. Closure: Femoral access site closure (suture device or surgical repair).

Indications

• Descending thoracic aortic aneurysm (>5.5 cm or symptomatic).
• Acute complicated Type B dissection.
• Penetrating aortic ulcer, traumatic transection.
• High surgical risk patients.

Advantages Over Open Repair

• Less physiologic stress, reduced blood loss, shorter ICU/hospital stay.
• Lower early mortality, paraplegia, and pulmonary complication rates.
• Faster return to function.

Considerations

• Requires adequate landing zones; may need debranching/revascularization.
• Lifelong imaging surveillance for endoleak, migration, stent fracture.
• Not suitable for ascending arch/arch involvement without hybrid/open approach.