Thoracic endovascular aneurysm repair

A thoracic endovascular aneurysm repair (TEVAR) is a type of endovascular aneurysm repair that involves the thoracic aorta.

Indications

It is a commonly applied treatment strategy for various thoracic aortic pathologies inclusive of both:

• type A and type B thoracic aortic dissections

• penetrating atherosclerotic ulcers of thoracic aorta

• thoracic aortic aneurysm

• thoracic aortic injury

  • thoracic aortic pseudoaneurysm

Contraindications

Recognized contraindications include ³:

• unfavorable anatomy

  • inadequate proximal or distal seal zones

  • tortuosity

  • lack of vascular access options or extremes of aortic diameter.

• placement into infected regions

Landing zones

An understanding of landing zones is useful for a reporting radiologist in pre-operative and post-operative assessment.

These zones are often numbered as: 

• zone 0: from distal to the coronary ostia  to proximal edge of innominate artery

• zone 1: from distal to innominate artery to proximal and involving the left common carotid artery

• zone 2: from distal to the left common carotid artery to proximal and involving the left subclavian artery

• zone 3: from distal margin of the left subclavian artery to 2 cm distal to the left subclavian artery

• zone 4: from 2 cm distal to the left subclavian artery to midpoint of the descending thoracic aorta

• zone 5: from midpoint of descending thoracic aorta to proximal margin of the celiac artery

• zone 6: from celiac artery origin to proximal margin of the superior mesenteric artery

• zone 7: from superior mesenteric artery to the remainder of suprarenal aorta

Complications

• endoleaks

• enlarging aneurysmal sac / aortic outer luminal growth - without a visible endoleak