Thoracic Endovascular Aortic Repair (TEVAR)

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Anum Ijaz M.B.B.S., M.D.[2]

Overview

Thoracic endovascular aortic repair (TEVAR) is a catheter-based technique for treatment of pathology involving the descending thoracic aorta, including thoracic aortic aneurysm (TAA), complicated and select uncomplicated type B aortic dissection (TBAD), blunt traumatic aortic injury (BTAI), penetrating aortic ulcer, and intramural hematoma. First performed in 1994 and FDA-approved for descending TAA in 2005, TEVAR has largely supplanted open surgical repair for most descending thoracic aortic pathology due to lower perioperative morbidity and mortality. Unlike endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms, which uses modular bifurcated devices, TEVAR employs a single tubular stent-graft deployed in the descending aorta.

Indications

Descending Thoracic Aortic Aneurysm

Per the 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease:[1]

  • Repair is recommended when descending TAA diameter is ≥5.5 cm (Class I, LOE B-NR).
  • Repair may be considered for growth rate ≥0.5 cm/year, saccular morphology, or symptomatic disease (Class IIb, LOE B-NR).
  • In patients at increased perioperative risk (advanced age, renal insufficiency, COPD, prior stroke), the size threshold for repair may be increased (Class IIb, LOE B-NR).
  • In patients without connective tissue disorders and with anatomy suitable for endovascular repair, TEVAR is recommended over open surgery (Class I, LOE B-NR).

Thoracoabdominal Aortic Aneurysm

  • Open repair is recommended when diameter is ≥6.0 cm (Class I, LOE B-NR).[1]
  • Endovascular repair with fenestrated/branched stent grafts may be considered in patients with suitable anatomy at centers with endovascular expertise (Class IIb, LOE B-NR).
  • Open repair is recommended over endovascular repair in patients with Marfan syndrome, Loeys-Dietz syndrome, or vascular Ehlers-Danlos syndrome (Class I, LOE C-LD).

Complicated Type B Aortic Dissection

Per the 2022 ACC/AHA and 2022 STS/AATS guidelines:[1][2]

  • Medical therapy is recommended as initial management for all patients with uncomplicated acute TBAD (Class I, LOE B-NR).
  • Intervention is recommended for acute TBAD with rupture or other complications (malperfusion, refractory pain, uncontrolled hypertension, rapid aortic expansion) (Class I, LOE C-LD).
  • In the presence of suitable anatomy, endovascular stent grafting is recommended over open repair for rupture (Class I, LOE C-EO) and is reasonable for other complications (Class IIa, LOE C-LD).
  • TEVAR may be considered for uncomplicated acute TBAD with high-risk anatomic features (Class IIb, LOE B-R).

Uncomplicated Type B Aortic Dissection

The role of TEVAR in uncomplicated TBAD remains evolving.

  • INSTEAD trial: 140 patients randomized to optimal medical therapy (OMT) + TEVAR vs. OMT alone for subacute/chronic uncomplicated TBAD. No mortality difference at 2 years. INSTEAD-XL (5-year follow-up) showed improved aorta-specific mortality with TEVAR (6.9% vs. 19.3%; HR 0.35; P=0.04) and reduced disease progression (27% vs. 46%; P=0.04).[3][2]
  • ADSORB trial: 61 patients with acute uncomplicated TBAD. At 1 year, aortic remodeling occurred in 57% of TEVAR patients vs. 3% with medical therapy alone (P<0.05).[3][2]
  • A meta-analysis of 15,066 patients found TEVAR for uncomplicated TBAD was associated with significantly lower long-term aorta-related death (OR 0.27), all-cause death (OR 0.52), and aortic rupture (OR 0.26) compared with medical therapy, though early outcomes were similar.[4]

Blunt Traumatic Aortic Injury

Per the 2022 ACC/AHA guidelines and 2024 EACTS/STS guidelines:[1][5]

  • TEVAR is the first-line treatment for BTAI when intervention is indicated and anatomy is suitable.
  • Grade I lesions can be managed nonoperatively with close surveillance.
  • Grade II lesions with high-risk imaging features (posterior mediastinal hematoma >10 mm, pseudocoarctation, hemothorax) should be considered for TEVAR.
  • Grade III–IV lesions should be managed operatively with TEVAR.
  • A systematic review of 991 patients showed technical success of 98%, 30-day mortality of 5%, spinal cord ischemia of 1%, and stroke of 2%.[6]

Preprocedural Planning

Anatomic Requirements

The thoracic aorta is divided into 11 landing zones (zones 0–10) based on relationship to arch branch vessels and abdominal visceral arteries.[1] Successful TEVAR requires:

  • Proximal and distal landing zones of ≥2.0 cm of normal aorta for adequate seal.[7][8]
  • Nonadherence to the 2-cm proximal landing zone is associated with significantly higher rates of type IA endoleak, graft migration, and retrograde dissection.[8]
  • Stent-graft oversizing of 10–20% relative to the native aortic diameter at the landing zone.

Imaging

The Society for Vascular Surgery (SVS) recommends (Grade 1, Quality A):[9]

  • Fine-cut CT angiography (CTA) of the entire aorta, iliac, and femoral arteries for preprocedural planning. The SVS specifies ≤0.25 mm pixel spacing; typical reconstructed slice thickness is ~1 mm, with ≤2 mm cuts recommended for 3D endovascular planning.
  • CTA of the head and neck to determine vertebral artery anatomy.
  • Routine use of 3D centerline reconstruction software for accurate case planning.
  • ECG-gated CTA for ascending aorta and arch measurements to minimize cardiac motion artifact.[7]

Vascular Access

  • TEVAR delivery systems typically range from 18–26F (7–9.5 mm outer diameter).[7]
  • Iliofemoral artery diameter, calcification, and tortuosity must be assessed.
  • Iliac conduits are required in approximately 10–20% of cases due to small or diseased access vessels.[10]
  • Alternative access (transapical, iliac conduit) should be considered when femoral access is inadequate.[1][7]

Procedural Technique

The TEVAR procedure follows a standardized sequence:

  1. Access: Percutaneous or open femoral artery access; brachial/radial access for diagnostic catheter placement.
  2. Diagnostic angiography: Aortogram with appropriate oblique angulation (typically 40° LAO) to delineate arch anatomy, branch vessels, and pathology. In dissection, true and false lumens must be clearly identified.
  3. Guidewire positioning: A stiff guidewire is advanced into the ascending aorta or aortic arch under fluoroscopic guidance, ensuring position in the true lumen.
  4. Device delivery: The stent-graft delivery system is advanced over the guidewire to the target deployment site.
  5. Deployment: The stent-graft is deployed under fluoroscopic guidance, typically with pharmacologically induced controlled hypotension (target systolic BP ~80–100 mmHg per institutional practice) to minimize windsock effect and optimize positioning accuracy. Postoperatively, mean arterial pressure should be maintained ≥80–90 mmHg to reduce spinal cord ischemia risk, particularly after extensive coverage.[5]

Adjunctive technique for malperfusion in dissection: Branch vessel stenting may be performed for persistent malperfusion despite coverage of the primary entry tear.[3]

PETTICOAT technique (Provisional Extension To Induce Complete Attachment): Placement of a proximal covered stent-graft to seal the primary entry tear, combined with a distal bare-metal stent to promote true lumen expansion and reduce distal malperfusion, in complicated TBAD. Evaluated in the STABLE I and II trials, which met prespecified effectiveness and safety endpoints, though long-term false lumen thrombosis in the bare-metal stent segment was unpredictable.[3][11]

Anticoagulation: The 2026 SVS focused update on the management of blunt thoracic aortic injury addresses periprocedural anticoagulation/antiplatelet strategy in trauma patients undergoing TEVAR, balancing thromboembolic risk against hemorrhage from concomitant injuries.[12]

Hybrid and Staged Arch Techniques

For pathology extending into or near the aortic arch, hybrid and staged surgical strategies extend the applicability of endovascular repair:[13][14][15]

  • Frozen elephant trunk (FET): A single-stage hybrid operation combining total aortic arch replacement (under circulatory arrest) with antegrade delivery of a stent-graft into the descending aorta. The stent-graft component provides a landing zone for potential future distal TEVAR extension. Early series report 30-day mortality of 5%, stroke of 5%, and transient SCI of 5%.[16]
  • Two-stage hybrid arch repair: First-stage total arch replacement with conventional elephant trunk, followed by second-stage TEVAR using the elephant trunk as a proximal landing zone. A series of 55 patients reported 0% in-hospital mortality for both stages and 5-year survival of 67%.[17]
  • Debranching with TEVAR: Surgical revascularization of arch vessels (carotid-carotid bypass, carotid-subclavian bypass) followed by TEVAR extending into the arch, reserved for patients who are not candidates for open arch replacement.

The 2024 EACTS/STS guidelines note that FET or open arch replacement should be considered for patients with TBAD who have a large ascending aorta/arch, retrograde extension, lack of an adequate TEVAR landing zone, or connective tissue disorders.[5]

Left Subclavian Artery Management

Coverage of the left subclavian artery (LSA) is necessary in 26–40% of TEVAR procedures to achieve adequate proximal seal.[9]

Guideline recommendations:

  • 2022 ACC/AHA: In patients undergoing TEVAR with planned LSA coverage, revascularization of the LSA before TEVAR is recommended to prevent spinal cord injury (Class I, LOE B-NR).[1]
  • 2021 SVS: For elective TEVAR where LSA coverage is necessary, preoperative or concomitant LSA revascularization is suggested (Grade 1, Quality B).[9]
  • 2022 STS/AATS: LSA revascularization is recommended to decrease the risk of spinal cord injury (SCI) if TEVAR coverage obstructs antegrade LSA flow.[2]

Revascularization techniques:

  • Open: Carotid-subclavian bypass, carotid-subclavian transposition, carotid-axillary bypass.
  • Endovascular: Branched endografts, chimney/parallel stents, in situ fenestration.
  • A Vascular Quality Initiative (VQI) analysis of 2,489 patients found endovascular LSA revascularization had lower stroke rates (2.6% vs. 4.8%; P=0.026) and lower composite in-hospital complications (20% vs. 27%; P<0.05) compared with open revascularization.[18]

Mandatory revascularization should be strongly considered when:[12]

  • A patent left internal mammary artery (LIMA) graft to a coronary bypass is present.
  • A dominant left vertebral artery or absent/hypoplastic right vertebral artery is present.
  • The left vertebral artery arises directly from the aorta.

Spinal Cord Protection

Spinal cord ischemia (SCI) is one of the most devastating complications of TEVAR, with overall rates of 0–10.6% for descending thoracic repair and permanent SCI rates of 0–5.1%.[19]

Risk factors for SCI:[19][9]

  • Length of aortic coverage >15 cm
  • Coverage of the LSA without revascularization
  • Prior or concomitant infrarenal aortic repair
  • Hypotension (intraoperative or postoperative)
  • Chronic renal failure
  • Extensive thoracoabdominal extent of disease

Prevention and mitigation strategies (multimodal approach):[19][9]

  • Cerebrospinal fluid (CSF) drainage: Controversial for routine use. A systematic review found SCI rates of 3.2% with and 3.5% without prophylactic CSF drainage; however, a meta-analysis including three RCTs concluded spinal drains prevent early SCI (OR 0.48; P=0.002; NNT=23). Selective use is recommended for high-risk patients (extensive coverage, prior aortic repair).
  • Blood pressure augmentation: Maintaining mean arterial pressure ≥80–90 mmHg postoperatively.
  • LSA revascularization: As detailed above.
  • Staged procedures: For extensive aortic coverage, staging repairs allows spinal cord preconditioning and collateral network development.
  • Neuromonitoring: Somatosensory and motor evoked potentials are rarely used for simple TEVAR but may be employed in complex cases.

Devices

Several FDA-approved thoracic stent-graft platforms are available:

Device Graft Material Stent Frame Notes
Gore TAG / Conformable TAG (CTAG) ePTFE Nitinol exoskeleton Most widely used device (~60% of BTAI repairs); the CTAG with ACTIVE CONTROL system allows staged deployment and angulation control[20]
Medtronic Valiant Captivia Polyester Nitinol Available with or without proximal bare stent[21]
Cook Zenith Alpha Polyester Stainless steel Z-stents —
Terumo RelayPro Polyester Bare stent proximal configuration —

Device selection should be individualized based on aortic anatomy, arch angulation, landing zone characteristics, and pathology. A study of 346 BTAI patients found that six stent-graft configurations spanning proximal diameters of 21–32 mm accommodate >90% of repairs; in-hospital mortality and endoleak rates did not differ among manufacturers.[22]

Complications

Endoleak

Endoleaks occur in up to 20–30% of patients after TEVAR and represent the most important risk factor for aortic rupture.[7][23] The 2022 ACC/AHA guidelines classify endoleaks into five types:[1]

Type Mechanism Management
I (IA proximal / IB distal) Leak at attachment site; persistent sac pressurization Represents treatment failure; requires immediate intervention
II Retrograde flow from branch vessels (intercostal, bronchial, LSA); most common type Intervention indicated if associated with sac enlargement; LSA-origin type II endoleaks required secondary intervention in 56% at 2 years[23]
III Leak through graft defect or between modular components Requires immediate repair
IV Graft porosity Typically self-limited
V (endotension) Sac expansion without an identifiable endoleak Continued surveillance; intervention if progressive

Type I and III endoleaks are treatment failures requiring urgent reintervention.[23] In a series of 82 TAA patients treated with TEVAR, 11% required reintervention at 60 months, primarily for type I endoleaks (7%).[9]

Retrograde Type A Aortic Dissection

Retrograde type A aortic dissection (RTAD) is an uncommon but life-threatening complication:[24][25][26]

  • Incidence: 1.6–2.5% (pooled estimates from systematic reviews)
  • Mortality: 33–42%
  • Most cases occur in the immediate postoperative period (58%)
  • Risk factors: TEVAR for acute dissection (OR 10.0 vs. aneurysm), excessive device oversizing (OR 1.14 per 1% increase above 9%), proximal bare-stent endografts (RR 2.06), more extensive dissection, and zone 0 landing.
  • The VQI TEVAR for Dissection Registry reported RTAD in 2.5% (15/588), with 33% mortality; factors associated with RTAD included more extensive dissection (8.5 vs. 5.6 zones; P=0.001) and female sex.[27]

Stroke and Other Complications

  • Stroke: Rates after TEVAR range from 2–5%, related to wire/catheter manipulation in the arch, embolization, and LSA coverage; LSA revascularization reduces stroke risk (see above).[10][6]
  • Stent-graft migration: 0.7–4%.[7]
  • Graft collapse: Rare but devastating.
  • Access-related complications: Iliac rupture, dissection.
  • Post-implantation syndrome: Fever, leukocytosis without infection.
  • Graft infection: Incidence of 0.2–5% for endovascular grafts overall, with TEVAR infection rates potentially higher than EVAR owing to procedural complexity and risk of aortobronchial or aortoesophageal fistula; the 2022 ACC/AHA guideline cites an overall aortic graft infection rate of 0.3–3%. Mortality is extremely high (approximately 66% in one systematic review of thoracic endograft infection). Surgical explantation is the preferred treatment strategy in patients fit for reoperation.[28][29][1]
  • Stent-graft-induced new entry (SINE): A distal (or, less commonly, proximal) complication of TEVAR for dissection, in which a new intimal tear develops at the stent-graft edge with re-entry flow into the false lumen; risk is influenced by device oversizing and radial force mismatch at the covered/bare-stent transition. Adjunctive configurations such as PETTICOAT-snowshoe have been developed to reduce distal SINE risk.[30]

Connective Tissue Disorders

In patients with Marfan syndrome, Loeys-Dietz syndrome, or vascular Ehlers-Danlos syndrome, open repair is recommended over endovascular repair for thoracoabdominal aortic aneurysm (TAAA) (Class I, LOE C-LD). For isolated descending TAA, the 2022 ACC/AHA guideline recommends TEVAR only in patients without these disorders (Class I, LOE B-NR); the guideline does not explicitly state that TEVAR is contraindicated as an outright rule for descending TAA in this population. The 2022 STS/AATS guideline states that open repair is reasonable for connective tissue disorder patients with TBAD (Class I, LOE B-NR), and that TEVAR is reasonable as a bridge to delayed open reconstruction in acute complicated TBAD (Class IIa, LOE C-LD). A 2026 Vascular Quality Initiative analysis of 330 connective tissue disorder patients undergoing TEVAR reported acceptable perioperative outcomes (mortality 2.1%, SCI 2.1%) but substantial midterm reintervention (30.8% at 18 months) and aneurysmal degeneration (40.2%).[1][2][31]

Post-TEVAR Surveillance

2022 ACC/AHA recommendations:[1]

  • CT angiography at 1 month and 12 months after TEVAR, and if stable, annually thereafter (Class I, LOE B-NR).
  • MRI is a reasonable alternative to CT to reduce long-term radiation exposure or avoid iodinated contrast in patients with allergy (Class IIa, LOE B-NR).

SVS and ACR recommendations:[9][7]

  • Clinical examination and CT scans at 1 month, 6 months, and yearly thereafter.
  • Earlier evaluation (during hospitalization or within 1 week) may be warranted for emergent TEVAR.
  • Surveillance should be tailored to the indication; certain pathologies (e.g., dissection) may warrant more frequent imaging.
  • Aorta-related complications occur in approximately 35% of patients, with sac expansion accounting for 77% of these.[9]

Surveillance goals:

  • Detect endoleaks (especially type I and III)
  • Monitor for sac expansion (7–15% of cases)
  • Identify stent-graft migration (0.7–4%), fracture, or collapse
  • Assess for retrograde type A dissection and stent-graft-induced new entry
  • Evaluate for graft infection or anastomotic pseudoaneurysm
  • Monitor progression of disease in untreated aortic segments

References

  1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 Isselbacher EM, Preventza O, Hamilton Black J; et al. (2022). "2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease". Journal of the American College of Cardiology. 80 (24): e223–e393. doi:10.1016/j.jacc.2022.08.004.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 MacGillivray TE, Gleason TG, Patel HJ; et al. (2022). "The Society of Thoracic Surgeons/American Association for Thoracic Surgery Clinical Practice Guidelines on the Management of Type B Aortic Dissection". The Annals of Thoracic Surgery. 113 (4): 1073–1092. doi:10.1016/j.athoracsur.2021.11.002.
  3. ↑ 3.0 3.1 3.2 3.3 Mussa FF, Kougias P (2025). "Management of Acute Type B Aortic Dissection". The New England Journal of Medicine. 393 (9): 895–905. doi:10.1056/NEJMra2405257.
  4. ↑ Wang J, Jin T, Chen B, Pan Y, Shao C (2022). "Systematic Review and Meta-Analysis of Current Evidence in Endograft Therapy vs Medical Treatment for Uncomplicated Type B Aortic Dissection". Journal of Vascular Surgery. 76 (4): 1099–1108.e3. doi:10.1016/j.jvs.2022.03.876.
  5. ↑ 5.0 5.1 5.2 Czerny M, Grabenwöger M, Berger T; et al. (2024). "EACTS/STS Guidelines for Diagnosing and Treating Acute and Chronic Syndromes of the Aortic Organ". European Journal of Cardio-Thoracic Surgery. 65 (2): ezad426. doi:10.1093/ejcts/ezad426.
  6. ↑ 6.0 6.1 Nana P, Spanos K, Behrendt CA; et al. (2024). "A Systematic Review on Thoracic Endovascular Repair Outcomes in Blunt Thoracic Aortic Injuries". Journal of Endovascular Therapy. doi:10.1177/15266028241233163.
  7. ↑ 7.0 7.1 7.2 7.3 7.4 7.5 7.6 Ripley B, Scheidt MJ, Aghayev A; et al. (2025). "ACR Appropriateness Criteria: Thoracic Aortic Aneurysm or Dissection—Treatment Planning and Follow-Up: 2024 Update". Journal of the American College of Radiology. 22 (5S): S455–S478. doi:10.1016/j.jacr.2025.02.019.
  8. ↑ 8.0 8.1 Yoon WJ, Mell MW (2020). "Outcome Comparison of Thoracic Endovascular Aortic Repair Performed Outside Versus Inside Proximal Landing Zone Length Recommendation". Journal of Vascular Surgery. 72 (6): 1883–1890. doi:10.1016/j.jvs.2020.03.033.
  9. ↑ 9.0 9.1 9.2 9.3 9.4 9.5 9.6 9.7 Upchurch GR, Escobar GA, Azizzadeh A; et al. (2021). "Society for Vascular Surgery Clinical Practice Guidelines of Thoracic Endovascular Aortic Repair for Descending Thoracic Aortic Aneurysms". Journal of Vascular Surgery. 73 (1S): 55S–83S. doi:10.1016/j.jvs.2020.05.076.
  10. ↑ 10.0 10.1 Feezor RJ, Huber TS, Martin TD; et al. (2007). "Perioperative Differences Between Endovascular Repair of Thoracic and Abdominal Aortic Diseases". Journal of Vascular Surgery. 45 (1): 86–9. doi:10.1016/j.jvs.2006.09.012.
  11. ↑ Rong D, Ge Y, Liu J, Liu X, Guo W (2019). "Combined Proximal Descending Aortic Endografting Plus Distal Bare Metal Stenting (PETTICOAT Technique) Versus Conventional Proximal Descending Aortic Stent Graft Repair for Complicated Type B Aortic Dissections". The Cochrane Database of Systematic Reviews. 2019 (10): CD013149. doi:10.1002/14651858.CD013149.pub2.
  12. ↑ 12.0 12.1 DuBose J, Kundi R, Curi MA; et al. (2026). "The Society for Vascular Surgery Clinical Practice Guideline on the Management of Blunt Thoracic Aortic Injury: A Focused Update". Journal of Vascular Surgery. doi:10.1016/j.jvs.2026.02.013.
  13. ↑ Karangelis D, Stougiannou TM, Christodoulou KC; et al. (2024). "Hybrid Aortic Arch Replacement With Frozen Elephant Trunk (FET) Technique: Surgical Considerations, Pearls, and Pitfalls". Journal of Clinical Medicine. 13 (23): 7075. doi:10.3390/jcm13237075.
  14. ↑ Porterie J, Hostalrich A, Dagenais F; et al. (2023). "Hybrid Treatment of Complex Diseases of the Aortic Arch and Descending Thoracic Aorta by Frozen Elephant Trunk Technique". Journal of Clinical Medicine. 12 (17): 5693. doi:10.3390/jcm12175693.
  15. ↑ Elhelali A, Hynes N, Devane D; et al. (2021). "Hybrid Repair Versus Conventional Open Repair for Thoracic Aortic Arch Aneurysms". The Cochrane Database of Systematic Reviews. 6: CD012923. doi:10.1002/14651858.CD012923.pub2.
  16. ↑ Chu MWA, Losenno KL, Dubois LA; et al. (2019). "Early Clinical Outcomes of Hybrid Arch Frozen Elephant Trunk Repair With the Thoraflex Hybrid Graft". The Annals of Thoracic Surgery. 107 (1): 47–53. doi:10.1016/j.athoracsur.2018.07.091.
  17. ↑ Yoshitake A, Iida Y, Yamazaki M; et al. (2019). "Midterm Results of 2-Stage Hybrid Arch Repair for Extensive Aortic Arch Aneurysms". Annals of Vascular Surgery. 56: 97–102. doi:10.1016/j.avsg.2018.07.063.
  18. ↑ Mandigers TJ, Allievi S, Jabbour G; et al. (2024). "Comparison of Open and Endovascular Left Subclavian Artery Revascularization for Zone 2 Thoracic Endovascular Aortic Repair". Journal of Vascular Surgery. 80 (5): 1425–1436.e3. doi:10.1016/j.jvs.2024.06.018.
  19. ↑ 19.0 19.1 19.2 Lella SK, Waller HD, Pendleton A; et al. (2022). "A Systematic Review of Spinal Cord Ischemia Prevention and Management After Open and Endovascular Aortic Repair". Journal of Vascular Surgery. 75 (3): 1091–1106. doi:10.1016/j.jvs.2021.10.039.
  20. ↑ Mariani C, van der Weijde E, Smith T; et al. (2019). "The GORE TAG Conformable Thoracic Stent Graft With the New ACTIVE CONTROL Deployment System". Journal of Vascular Surgery. 70 (2): 432–437. doi:10.1016/j.jvs.2018.11.015.
  21. ↑ Mao L, Luan J, Yang Y; et al. (2023). "The Efficacy and Safety of Gore Conformable Thoracic Stent Graft and Valiant Captivia Thoracic Stent Graft for Acute Type B Aortic Dissection". International Journal of Cardiology. 382: 3–11. doi:10.1016/j.ijcard.2023.03.060.
  22. ↑ Yep Mendizabal F, MacHugh A, Crapps J; et al. (2026). "Value-Based Approach to Stent-Graft Inventory Selection for Blunt Thoracic Aortic Injury: Multi-Center, Multi-Manufacturer Analysis From the Aortic Trauma Foundation". Journal of the American College of Surgeons. doi:10.1097/XCS.0000000000002094.
  23. ↑ 23.0 23.1 23.2 Zierler RE, Jordan WD, Lal BK; et al. (2018). "The Society for Vascular Surgery Practice Guidelines on Follow-Up After Vascular Surgery Arterial Procedures". Journal of Vascular Surgery. 68 (1): 256–284. doi:10.1016/j.jvs.2018.04.018.
  24. ↑ Canaud L, Ozdemir BA, Patterson BO; et al. (2014). "Retrograde Aortic Dissection After Thoracic Endovascular Aortic Repair". Annals of Surgery. 260 (2): 389–95. doi:10.1097/SLA.0000000000000585.
  25. ↑ Ali-Hasan-Al-Saegh S, Halloum N, Scali S; et al. (2023). "A Systematic Review and Meta-Analysis of Retrograde Type A Aortic Dissection After Thoracic Endovascular Aortic Repair in Patients With Type B Aortic Dissection". Medicine. 102 (15): e32944. doi:10.1097/MD.0000000000032944.
  26. ↑ Chen Y, Zhang S, Liu L; et al. (2017). "Retrograde Type A Aortic Dissection After Thoracic Endovascular Aortic Repair: A Systematic Review and Meta-Analysis". Journal of the American Heart Association. 6 (9): e004649. doi:10.1161/JAHA.116.004649.
  27. ↑ Beck AW, Wang G, Lombardi JV; et al. (2022). "Retrograde Type A Dissection in the Vascular Quality Initiative Thoracic Endovascular Aortic Repair for Dissection Postapproval Project". Journal of Vascular Surgery. 75 (5): 1539–1551. doi:10.1016/j.jvs.2021.11.075.
  28. ↑ Wilson WR, Bower TC, Creager MA; et al. (2016). "Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association". Circulation. 134 (20): e412–e460. doi:10.1161/CIR.0000000000000457.
  29. ↑ Moulakakis KG, Mylonas SN, Antonopoulos CN; et al. (2014). "Comparison of Treatment Strategies for Thoracic Endograft Infection". Journal of Vascular Surgery. 60 (4): 1061–71. doi:10.1016/j.jvs.2014.07.012.
  30. ↑ Orimoto Y, Ishibashi H, Maruyama Y; et al. (2022). "The PETTICOAT-Snowshoe Technique Prevents Distal Stent Graft-Induced New Entry in Patients With Aortic Dissection". Annals of Vascular Surgery. 84: 201–210. doi:10.1016/j.avsg.2022.01.013.
  31. ↑ Chamseddine H, Halabi M, Shepard A; et al. (2026). "Outcomes of Thoracic Endovascular Aortic Repair for Thoracic Aortic Disease in Patients With Connective Tissue Disorders: Insights From the Vascular Quality Initiative". Annals of Vascular Surgery. doi:10.1016/j.avsg.2026.06.053.
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