ABSTRACT
Open surgical repair of thoracic aortic aneurysms (TAA) was first performed in the 1950s. There have been significant advances in surgical techniques, anesthetic regimens, and perioperative care; however, the morbidity and mortality of these open procedures remains significant. In addition, the patient population presenting with thoracic aortic disease has become increasingly older and harbors more concomitant comorbidities. Thoracic endovascular aortic repair (TEVAR) emerged as a complementary treatment paradigm to minimize the morbidity and mortality associated with open repair for aneurysms of the thoracic aorta. Several nonrandomized studies have documented improved mortality and morbidity (shorter length of stay, improved paraplegia rates, less bleeding complications) for the TEVAR approach. The US Food and Drug Administration (FDA) granted initial endograft approval for treatment of TAA in 2005, and presently four companies manufacture FDA-approved devices. Since then, indications for use have expanded with broader FDA approval for all lesions of the descending thoracic aorta. Furthermore, the myriad advancements in endovascular technology continue to expand the pool of patients who may be amenable to undergoing TEVAR for increasingly complex thoracic aortic pathology, especially involving the aortic arch.
