REVIEW

Sizing and planning for TEVAR: How to do?

Since the milestone publication by Dake et al. thoracic endovascular aortic repair (TEVAR) has become a standardized procedure in endovascular aortic surgery [1]. It is performed in various pathologies of the thoracic aorta, e.g. aneurysms, traumatic rupture, dissections and penetrating aortic ulcers. Midterm results are encouraging with up to 97% technical success, 30-d mortality of 5.5% and neurological complications about 2–3% [2], [3]. For some indications TEVAR is nowadays considered to be treatment of first choice: patients with blunt traumatic aortic injuries who undergo TEVAR show significant better survival as compared to open repair in this situation [4]. For degenerative aortic aneurysm there is consensus that TEVAR demonstrates low early operative mortality rates of about 5.7% [5]. However in the long term late complications such as endoleaks and graft migration may occur and require secondary interventions [6], [7]. Nonetheless the good results in terms of morbidity and mortality have driven the endovascular approach to the thoracic aorta and reduced numbers of open repair in the descending part of it [8]. Like in open surgery that requires years of training TEVAR also requires adequate surgical and interventional skills including proper planning of the procedure. However there are hardly any reports or reviews dealing with this issue. This is predominantly attributed to the fact that TEVAR is more complicated and not as standardizable as infrarenal endovascular repair. Pathologies are diverse, the anatomy is not as straight as in the infrarenal aorta and most pathologies involve supraaortic vessels, predominantly the lefts subclavian artery.

Hence the aim of this review is to give a hand to all those endovascular surgeons who plan and perform TEVAR procedures.