TEVAR - the devices -summary

SUMMARY 
for full paper :
http://dqsendovascular.blogspot.kr/2012/10/tevar-devices-part-1.html
http://dqsendovascular.blogspot.kr/2012/10/talent-thoracic-stent-graft-system.html

Endovascular repair of the thoracic aorta is becoming increasingly popular due to reduced perioperative morbidity and mortality compared with open surgical repair. Endovascular repair with stent-graft devices can be used to treat thoracic aortic aneurysm, aortic dissection, aortic rupture including traumatic rupture, penetrating aortic ulcer and nontraumatic aortic intramural hematoma. Endovascular aortic repair requires that specific anatomic criteria be fulfilled, and, for those with appropriate anatomy, this technique allows the treatment of patients who might not otherwise be candidates for aortic repair.

Endovascular aneurysm repair refers to the stepwise insertion of endovascular graft components, usually via a femoral approach. Although there are significant variations in endovascular graft design, three types of components are common to all: a delivery system, main body device, and graft extensions. Upon deployment, the endograft expands, contacting the thoracic aortic wall proximally and distally excluding the degenerated aortic wall from aortic blood pressure and flow.

When aortic disease is more extensive and involves branch vessels, the complexity and risks associated with endovascular repair increase. Approaches to address these issues include debranching procedures and the use of fenestrated and branched endografts. Advanced endovascular aortic devices are designed to allow perfusion into specific aortic branch arteries depending upon the level of repair

The indications for endovascular treatment of thoracic aortic pathologies are expanding, and the cases being treated are increasingly complex. Although graft design has evolved, an ideal graft suited to all circumstances is not available. A number of thoracic stent graft devices are available and include the TAG™, Zenith® Tx2®, Talent® Thoracic Stent-Graft System, and Valiant™ Thoracic Stent-Graft System. The Relay™, TAArget™, and E-Vita® grafts remain investigational in the United States.

There are no trials comparing the outcomes of specific endovascular stent-grafts to each other for the management of thoracic aortic pathology. The placement of aortic endovascular grafts is associated with device-related complications that can include component disconnect, stent-graft buckling and migration over time. In the thoracic aorta, secondary intervention is needed in 10 to 60 percent of patients, more commonly in patients undergoing endovascular repair of thoracic dissection. As such, these devices require lifelong surveillance; long-term outcomes continue to be studied.