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TEVAR (Thoracic Endovascular Aortic Repair) is a minimally invasive procedure that involves the deployment of a stent-graft via catheter-based technique to exclude diseased segments of the thoracic aorta (e.g., aneurysms, dissections, ulcers) from systemic circulation.
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It is the preferred treatment for descending thoracic aortic pathology in select patients, offering lower perioperative morbidity compared to open surgery.
| Primary Indications | Aortic Pathologies Treated |
|---|---|
| Descending thoracic aortic aneurysm (DTAA) | Fusiform or saccular ≥ 6.0 cm or rapidly enlarging |
| Thoracic aortic dissection | Type B dissections (especially complicated/ruptured) |
| Intramural hematoma or penetrating atherosclerotic ulcer (PAU) | Especially with symptoms or progression |
| Traumatic aortic injury | Especially at aortic isthmus (grade II–IV injury) |
| Aortic pseudoaneurysm | From trauma, infection, or prior surgery |
| Aorto-bronchial or aorto-esophageal fistula | Emergency stabilization with TEVAR |
| Chronic post-dissection aneurysm | In expanding false lumen |
| Absolute | Relative |
|---|---|
| Inadequate vascular access | Unfavorable aortic anatomy |
| Severe allergy to contrast agents | Limited landing zones without debranching options |
| Active systemic infection | Renal insufficiency (caution with contrast use) |
| Step | Description |
|---|---|
| Access | Typically via femoral arteries (percutaneous or cutdown) |
| Sheath and guidewire | Introduced under fluoroscopic guidance |
| Stent graft deployment | Across the aneurysm/dissection, covering landing zones |
| Post-deployment angiography | Confirms positioning, exclusion, and branch patency |
| Adjuncts | LSA revascularization, chimney grafts, or hybrid debranching if needed |