TEVAR is no longer just a less invasive alternative to open repair — across type B dissection, traumatic injury, and thoracic aneurysm, it has become a strategy whose success depends on timing, landing-zone judgment, branch preservation, and complication control. This review shows where TEVAR clearly wins, where the evidence is still conflicted, and which technical decisions most strongly shape survival, remodeling, and long-term failure.
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Abstract: The aim of this scoping review is to synthesize the current evidence regarding the clinical outcomes, technical advancements, and complication profiles of thoracic endovascular aortic repair (TEVAR) across diverse aortic substrates, with a focus on optimizing patient selection and procedural timing. The review utilises 2530 original studies with 3319112 total participants (topic deduplicated ΣN). The mapped evidence supports TEVAR as the dominant contemporary strategy for descending thoracic aortic pathology, with consistent signals of lower perioperative mortality compared with open surgical repair (in-hospital mortality 5.9% versus 15.3% in acute type B aortic dissection) and improved 5-year survival relative to medical therapy (91.9% versus 82.2% in acute uncomplicated type B aortic dissection). Across the dominant research topics, TEVAR was associated with favorable false lumen thrombosis (up to 72.1% versus 20.0% with medical therapy) and superior aortic remodeling, particularly when performed in the subacute window, while controlled device-trial data also indicated lower aneurysm-related mortality for descending thoracic aneurysms in anatomically suitable patients. Recurrent signals across topics highlight that left subclavian artery management, proximal landing zone selection, oversizing strategy, and frailty status modulate risk of stroke, spinal cord ischemia, distal stent graft-induced new entry, and retrograde type A dissection, indicating that procedural success is anatomy- and patient-specific rather than uniformly favorable. Clinically, this evidence map supports a tailored approach combining subacute timing when feasible, selective left subclavian artery revascularization, conservative oversizing, and lifelong imaging surveillance for endoleak and aneurysmal progression. The most prominent uncertainty concerns preemptive TEVAR in uncomplicated type B aortic dissection, where randomized and observational data remain discordant on long-term mortality benefit. Future research should prioritize adequately powered randomized trials in high-risk uncomplicated type B aortic dissection, standardized definitions for distal stent graft-induced new entry and post-implantation syndrome, and prospective evaluation of patient-specific computational and digital twin planning to refine device selection and landing-zone strategy.
Final search date and database lock: 2026-04-28 12:06:09 CEST
Plan: Pro (expanded craft tokens; source: PubMed)
Source: PubMed
Total Abstracts/Papers: 4017
Downloaded Abstracts/Papers: 4017
Included original and non-original Abstracts/Papers (all): 2909
Included original Abstracts/Papers (Vote counting by direction of effect): 2530
Reference Index (links used in paper): 244
Total participants (topic deduplicated ΣN): 3319112
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[2071] Detection of Endoleaks Following Thoracic and Abdominal Aortic Endovascular Aortic Repair-: A Comparison of Standard and Dynamic 4D-Computed Tomography Angiography. — https://doi.org/10.1177/15266028221095390
[2079] In Situ Fenestration and Carotid-Subclavian Bypass for Left Subclavian Artery Revascularization During Thoracic Endovascular Aortic Repair. — https://doi.org/10.1007/s00270-024-03675-3
[2090] Low incidence of paraplegia after thoracic endovascular aneurysm repair with proactive spinal cord protective protocols. — https://doi.org/10.1016/j.jvs.2012.12.032
[2103] Thoracic Endovascular Repair for Aortic Arch Pathologies with Surgeon Modified Fenestrated Stent Grafts: A Multicentre Retrospective Study. — https://doi.org/10.1016/j.ejvs.2021.07.017
[2120] Systemic immune-inflammation index predicted the clinical outcome in patients with type-B aortic dissection undergoing thoracic endovascular repair. — https://doi.org/10.1111/eci.13692
[2146] Mechanisms of symptomatic spinal cord ischemia after TEVAR: insights from the European Registry of Endovascular Aortic Repair Complications (EuREC). — https://doi.org/10.1583/11-3578.1
[2169] Comparative effectiveness and safety of laser, needle, and "quick fenestrater" in fenestration during thoracic endovascular aortic repair. — https://doi.org/10.3389/fcvm.2023.1250177
[2189] Hemodynamics of different configurations of the left subclavian artery parallel stent graft for thoracic endovascular aortic repair. — https://doi.org/10.1016/j.cmpb.2023.107741
[2195] Female sex independently predicts mortality after thoracic endovascular aortic repair for intact descending thoracic aortic aneurysms. — https://doi.org/10.1016/j.jvs.2016.12.103
[2198] Uncertainty quantification for patient-specific domain in virtual aortic procedures: application to thoracic endovascular aortic repair. — https://doi.org/10.1007/s10237-025-02036-4
[2232] Preemptive treatment in the acute and early subacute phase of uncomplicated type B aortic dissections with poor prognosis factors. — https://doi.org/10.3389/fcvm.2024.1362576
[2282] Successful Endovascular Repair of a Thoracic Infected Aortic Aneurysm with Concomitant Liver Abscess: A Case Report. — https://doi.org/10.12659/ajcr.949749
[2316] Risk factors for acute kidney injury and its impact on 3-year mortality after thoracic endovascular repair for type B aortic dissection. — https://doi.org/10.3389/fcvm.2025.1691995
[2392] Mixed Reality-Assisted Thoracic Endovascular Aortic Repair: A Retrospective Study on Efficacy and Safety. — https://doi.org/10.1111/anec.70184
[2406] Association Between Preoperative Monocyte to High-Density Lipoprotein Ratio on In-hospital and Long-Term Mortality in Patients Undergoing Endovascular Repair for Acute Type B Aortic Dissection. — https://doi.org/10.3389/fcvm.2021.775471
[2418] Endovascular versus surgical left subclavian artery revascularization with thoracic endovascular aortic repair involving the aortic arch. — https://doi.org/10.1016/j.jvs.2025.02.019
[2435] Impact of Female Sex on Outcomes of Patients Undergoing Thoracic Endovascular Aortic Aneurysm Repair: A Ten-Year Retrospective Nationwide Study in France. — https://doi.org/10.3390/jcm11082253
[2502] Midterm Outcomes of an Adjustable Puncture Device for In Situ Fenestration During Thoracic Endovascular Aortic Repair. — https://doi.org/10.1016/j.ejvs.2021.09.028
[2510] Association Between Geriatric Nutritional Risk Index and Discharge Outcome after Elective Thoracic Endovascular Aortic Repair. — https://doi.org/10.1007/s00270-025-04066-y
[2516] Thoracic Endovascular Aortic Repair With Additional Distal Bare Stents in Type B Aortic Dissection Does Not Prevent Long-Term Aneurysmal Degeneration. — https://doi.org/10.1177/15266028211007459
[2546] The role of geriatric nutritional risk index in predicting survival of type B aortic dissection patients after thoracic endovascular aortic repair. — https://doi.org/10.1016/j.jnha.2025.100572
[2588] Can Low-Iodine, Low-Radiation-Dose CT Aortogram Reliably Detect Endoleak after Endovascular Aneurysm Repair of the Aorta? — https://doi.org/10.3390/diagnostics13132228
[2599] Incidence and predictors of early and delayed renal function decline after aortic aneurysm repair in the Vascular Quality Initiative database. — https://doi.org/10.1016/j.jvs.2021.04.049
[2639] Suture-Based Vascular Closure Versus Surgical Closure of Large Bore Arteriotomies: A Real-World Experience. — https://doi.org/10.7759/cureus.54856
[2669] Comparison of chimney technique and single-branched stent graft in a cohort of patients with type B aortic dissections: a retrospective cohort study. — https://doi.org/10.21037/cdt-23-449
[2693] 'Post-Close' Femoral Arterial Haemostasis at Endovascular Aneurysm Repair using a Dedicated Large-Bore Vascular Closure Device: A Prospective Real-World Audit. — https://doi.org/10.1007/s00270-023-03437-7
[2787] Five-year results of endovascular treatment with the Gore TAG device compared with open repair of thoracic aortic aneurysms. — https://doi.org/10.1016/j.jvs.2007.12.006
[2834] Occlusion of the Celiac Artery during Endovascular Thoracoabdominal Aortic Aneurysm Repair Is associated with Increased Perioperative Morbidity and Mortality. — https://doi.org/10.1016/j.avsg.2020.01.102
[2846] Impact of Residual Intimal Flap Displacement Post-TEVAR on TBAD Haemodynamics in Compliant, Patient-specific CFD Simulations Informed by MRI. — https://doi.org/10.1007/s10439-025-03739-6
