Thoracic endovascular aortic repair

Last revised by Joshua Kogan on 4 Dec 2024

A thoracic endovascular aortic repair (TEVAR) is a type of endovascular aneurysm repair of the thoracic aorta by insertion of a stent.

TEVAR is an effective treatment for a wide variety of thoracic aortic pathologies, including:

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

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

  • endoleak

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

  • incomplete or missed coverage of the primary intimal tear

  • stent-graft–induced new entry (SINE) tear

  • stent / graft migration

  • infection

  • arterial thromboembolism

Cases and figures

  • Case 1
  • Case 2
  • Case 3
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