TEVAR stands for thoracic endovascular aortic repair, a minimally invasive procedure that fixes damage to the aorta in your chest. Rather than opening the chest with a large incision, surgeons thread a small fabric-covered tube called a stent graft through a blood vessel in your groin and guide it up to the damaged section of the aorta, where it reinforces the weakened wall from the inside. It’s most commonly used to treat aneurysms (bulging weak spots) and dissections (tears in the vessel wall) in the descending thoracic aorta.
Why TEVAR Is Performed
The aorta is your body’s largest artery, carrying blood from the heart to the rest of your body. When the wall of the thoracic aorta weakens, it can balloon outward into an aneurysm or tear apart in a dissection. Both conditions risk a life-threatening rupture. TEVAR reinforces that section of the aorta so blood flows through the stent graft instead of pressing against the damaged wall.
The most common reasons for TEVAR include:
- Thoracic aortic aneurysm: Elective repair is typically recommended when the aorta reaches 55 to 60 mm in diameter, or when it’s expanding more than 10 mm per year.
- Type B aortic dissection: TEVAR is a first-line treatment when a tear in the descending aorta causes complications like rupture or blocked blood flow to organs. Even in uncomplicated dissections, it may be considered to reduce the risk of problems later.
- Blunt thoracic aortic injury: High-force trauma, such as a car accident, can damage the aorta. TEVAR is now the preferred repair method in most of these cases.
Smaller aneurysms that haven’t reached the surgical threshold are monitored with regular imaging. An initial aortic diameter of 40 mm or a false lumen (the channel created by a tear) of 22 mm are both independent predictors that the aorta will continue to enlarge and eventually need repair.
How the Procedure Works
TEVAR is performed under general anesthesia, though regional anesthesia is sometimes used. The surgeon makes a small incision in the groin to access the femoral artery, one of the large blood vessels in your upper leg. A thin, flexible wire is inserted into the artery and advanced up through the aorta under real-time X-ray guidance (fluoroscopy). The collapsed stent graft rides along this wire inside a delivery catheter.
Once positioned at the damaged segment, the stent graft is released from its sheath and expands against the aorta wall, creating a new channel for blood to flow through. For aneurysms, this takes pressure off the bulging wall. For dissections, it seals the tear so blood can no longer push into the false channel. After the graft is in place, the delivery system is withdrawn and the groin incision is closed.
One critical requirement is a healthy “landing zone,” the stretch of normal aorta above and below the damage where the stent graft needs to anchor and seal. Most devices require at least 2 cm of healthy aorta at each end. Achieving that seal is essential; studies show that falling short of the recommended landing zone length significantly increases the risk of the device shifting or leaking. Not everyone’s anatomy allows for this, which is one reason TEVAR isn’t suitable for all patients.
TEVAR vs. Open Surgical Repair
Before TEVAR became widely available, the only option was open surgery, which requires a large chest incision, temporarily clamping the aorta, and replacing the damaged section with a synthetic graft. Open repair is a much larger operation with a significantly longer recovery.
The short-term survival advantage of TEVAR over open repair is substantial. In a large analysis published in the Journal of the American College of Cardiology, patients who had open surgery were roughly twice as likely to die in the period immediately after surgery compared to TEVAR patients at high-volume centers. At low-volume centers, the risk was more than three and a half times higher for open repair. This gap is one of the main reasons TEVAR has become the preferred approach when anatomy allows it. Open repair, however, may still be recommended for younger patients or those whose aortic anatomy doesn’t accommodate a stent graft, as some data suggest open surgery carries a lower risk of death in the years after the initial procedure.
Risks and Possible Complications
TEVAR is far less invasive than open surgery, but it still carries risks. The most significant ones relate to the spinal cord and brain, both of which depend on blood vessels that branch off the aorta.
Spinal cord injury is the complication patients worry about most. Covering a section of the aorta with a stent graft can block small arteries that feed the spinal cord, potentially causing weakness or paralysis in the legs. Historically, this occurred in 20% to 30% of patients with extensive aortic disease, but modern prevention strategies have driven the rate much lower. In recent studies, overall spinal cord injury rates after TEVAR range from under 1% to around 5%, depending on how much of the aorta is covered and the patient’s other medical conditions. Most cases involve temporary symptoms like tingling or mild weakness that resolve completely. Permanent paralysis occurs in roughly 2% or fewer of cases in recent data.
Other complications to be aware of include stroke, endoleak (blood leaking around the graft back into the aneurysm sac), damage to the artery at the groin access site, and kidney problems from the contrast dye used during imaging. Endoleaks are unique to endovascular repair and are one of the main reasons lifelong follow-up imaging is necessary.
Recovery After TEVAR
Because there’s no large chest incision, recovery from TEVAR is considerably faster than from open surgery. Most patients spend a few days in the hospital, including time in an intensive care unit for close monitoring of blood pressure, kidney function, and neurological status. Your care team will check leg strength and sensation frequently in the first 24 to 48 hours to catch any early signs of spinal cord problems.
Once home, most people can walk and handle light daily activities within a week or two. Driving and lifting restrictions typically last several weeks, though the exact timeline varies by surgeon. The groin incision site may be sore or bruised for a few days. Full return to normal activity, including exercise, generally takes four to six weeks.
Long-Term Follow-Up Schedule
Unlike open repair, where the synthetic graft is sewn directly into the aorta, a TEVAR stent graft is held in place by the pressure of the device against the vessel wall. That means it can potentially shift, develop leaks, or require additional procedures over time. Lifelong imaging surveillance is a non-negotiable part of living with a stent graft.
The Society for Vascular Surgery recommends a contrast-enhanced CT scan at 1 month and 12 months after TEVAR for aneurysms, then annually. If the one-month scan shows anything abnormal, an additional scan at 6 months is added. For patients who had TEVAR for an aortic dissection, the schedule is more frequent: CT scans at 1 month, 6 months, and 12 months, then annually from that point on. Patients treated for traumatic aortic injury follow the same protocol as aneurysm patients.
These scans check for endoleaks, confirm the graft hasn’t migrated, and monitor the size of any remaining aneurysm sac or untreated segments of the aorta. If a problem is found, it can often be corrected with a second endovascular procedure rather than open surgery.