Results and clinical consequences of trials on thoracic endografting

Abstract

Thoracic endovascular repair (TEVR) has developed from endovascular treatment of infra-renal aortic aneurysms, and is now considered first line treatment for a variety of thoracic aortic pathologies. In contrast to infra-renal repair, with its large evidence base and randomised control trials, most of the existing data on TEVR is from smaller industry run trials designed to evaluate the safety of a particular device. The aim of this review is to describe these studies with respect to peri-operative adverse events, frequency of device failure, mid-term aortic death, mid-term overall survival and freedom from re-intervention. The results are discussed in the context of their implications for clinical practice, taking into account the relative strengths and weakness of the available data. Where the individual trial design allows, direct comparison is made between TEVR and open surgical controls. The role of TEVR for specific pathologies is also discussed.