Understanding TEVAR: A Guide to Thoracic Endovascular Aneurysm Repair

Thoracic Endovascular Aneurysm Repair, commonly known as TEVAR, is a minimally invasive procedure used to treat thoracic aortic aneurysms. This method has changed how aortic aneurysm repair is done, especially in cases where open surgery might be too risky. As awareness of vascular conditions like abdominal aortic aneurysms and thoracic aortic aneurysms increases, many patients and families seek practical information about TEVAR, endovascular aneurysm repair (EVAR), and similar endovascular procedures.

An aortic aneurysm refers to a bulge or weakening in the wall of the aorta, the major blood vessel that carries blood from the heart to the rest of the body. When it occurs in the chest, it is called a thoracic aortic aneurysm.

If the aneurysm ruptures, it can cause life-threatening bleeding. TEVAR is one of the preferred treatment options for patients with certain aortic conditions because of its shorter recovery time and reduced risk compared to open surgery.

Endovascular aneurysm repair, whether for abdominal or thoracic regions, uses a stent graft to reinforce the weakened part of the aorta. This blog discusses TEVAR in detail, from the condition it treats to how the procedure is done, how it compares to open surgery, and answers to commonly searched questions about endovascular repair techniques. It also includes cost estimates, recovery expectations, and a comparison of treatment options.

If you or your loved one has been diagnosed with a thoracic or abdominal aortic aneurysm, knowing about TEVAR and similar methods like EVAR (endovascular aneurysm repair) and FEVAR (fenestrated endovascular aneurysm repair) can be essential when talking with a vascular surgeon. Keep reading to understand what TEVAR involves, how it helps, and what you should expect before and after the surgery.

What Is a Thoracic Aortic Aneurysm (TAA)?

A thoracic aortic aneurysm (TAA) occurs above the diaphragm in the upper part of the aorta. This condition involves a balloon-like bulge in a weakened section of the aortic wall. If the aneurysm grows too large, it can rupture and cause fatal internal bleeding. Many TAAs grow slowly and don’t cause symptoms until they are large.

TAAs can be caused by several factors, including high blood pressure, connective tissue disorders like Marfan syndrome, ageing, and trauma. Infections and inflammatory diseases can also lead to aneurysm growth. Diagnosing a TAA early is difficult because most patients do not feel symptoms in the early stages.

When symptoms do appear, they may include:

Chest or back pain
Coughing or hoarseness
Shortness of breath
Difficulty swallowing

The most common imaging tools used to diagnose TAAs are CT angiography, MRI, and ultrasound. These tests help doctors measure the size and shape of the aneurysm. Doctors recommend repair when the aneurysm reaches a size of around 5.5 cm or if it is rapidly expanding. The risk of aneurysm rupture increases significantly once it crosses this threshold.

Comparison of Thoracic and Abdominal Aortic Aneurysms

Feature	Thoracic Aortic Aneurysm	Abdominal Aortic Aneurysm
Location	Chest (thoracic aorta)	Lower abdomen (abdominal aorta)
Common symptoms	Chest pain, hoarseness	Back pain, abdominal pain
Typical cause	Hypertension, genetic	Atherosclerosis, smoking
Rupture risk threshold	>5.5 cm	>5.0 cm
Preferred treatment	TEVAR	EVAR

Regular monitoring is essential if a TAA is found. Lifestyle changes like managing blood pressure and quitting smoking are critical to slow the growth. In cases where the aneurysm involves branching arteries or is close to the heart, more complex procedures such as FEVAR (fenestrated endovascular aneurysm repair) or open surgical repair may be necessary.

What Is TEVAR?

TEVAR stands for Thoracic Endovascular Aneurysm Repair. It is a type of endovascular surgery used to repair the thoracic section of the aorta by placing a stent graft to prevent aneurysm rupture. TEVAR is considered a minimally invasive procedure because it avoids the need to open the chest.

TEVAR is usually recommended for:

Large or symptomatic thoracic aortic aneurysms
Traumatic injury to the thoracic aorta
Penetrating aortic ulcers
Aortic dissections in the descending thoracic aorta

The main goal of TEVAR is to isolate the aneurysm sac from blood flow. A stent graft is placed through the femoral arteries in the groin area, guided using X-ray imaging into the thoracic aorta. Once in place, it expands to line the vessel and redirect blood through a stable channel.

Though both TEVAR and EVAR use similar techniques, the anatomy and risks differ. TEVAR often requires extra planning due to the complexity of the thoracic aorta, including proximity to the heart, spinal cord, and branching arteries like the subclavian or visceral arteries.

TEVAR is not suitable for every patient. The decision is based on several factors, including the location and size of the aneurysm, vascular anatomy, and whether the proximal aortic neck is stable for stent graft anchoring. Complex aneurysms that involve renal arteries or the aortic arch may require advanced procedures like FEVAR.

The cost of TEVAR varies widely. On average, TEVAR in India can cost between INR 4,00,000 and INR 9,00,000. These costs are estimates and may vary based on hospital infrastructure, complications, length of stay, and whether special devices like fenestrated stent grafts are used.

How TEVAR Works: Step-by-Step Procedure

The TEVAR procedure is planned using detailed imaging of the aorta. Here are the main steps involved:

Pre-operative Assessment:
- Patients undergo CT angiography to map the aneurysm and surrounding arteries.
- Blood pressure and blood clotting profiles are checked.
Anesthesia and Access:
- General or regional anesthesia is administered.
- A small incision is made in the groin to access the femoral arteries.
Stent Graft Delivery:
- A catheter is used to carry the stent graft through the arteries to the thoracic aorta.
- The expandable stent graft is placed across the aneurysm site.
Positioning and Deployment:
- Fluoroscopy guides the positioning.
- Once in place, the stent graft is expanded to fit the aortic lumen.
Post-Deployment Monitoring:
- A contrast dye is injected to confirm there is no endoleak.
- Blood flow is checked to ensure proper circulation.
Recovery:
- Most patients spend 1-3 days in the hospital.
- Return to normal activity within 1-2 weeks.

Endovascular stent graft repair has reduced the risk of major complications compared to open surgical repair. However, the risk of spinal cord injury, blood transfusion needs, or kidney failure still exists in rare cases.

Regular follow-up is important after TEVAR. Imaging is repeated at 1, 6, and 12 months to ensure the aneurysm sac is shrinking and there is no migration or blood leak around the graft.

TEVAR vs. Open Surgery

TEVAR and open surgery are two very different approaches to aortic aneurysm repair. Open surgery involves making a large incision in the chest and replacing the damaged part of the aorta with a synthetic graft. TEVAR, on the other hand, uses endovascular techniques through the femoral arteries.

Feature	TEVAR	Open Surgery
Incision	Small groin incision	Large chest incision
Hospital stay	1-3 days	7-10 days
Recovery time	1-2 weeks	6-8 weeks
Blood loss	Minimal	Significant
Risk for elderly	Lower	Higher
Use of heart-lung machine	No	Yes

While TEVAR is less invasive, not every patient qualifies for it. Open surgery may be necessary in cases where:

The aneurysm involves the aortic arch or ascending aorta
There is not enough healthy tissue to anchor the stent graft
There are infections or blood clot complications

Many vascular surgeons evaluate anatomy using CT angiography before deciding the best method. Factors like age, cardiovascular surgery history, vascular anatomy, and previous endovascular treatment also influence this decision.

Risks and Complications of TEVAR

Although TEVAR is a minimally invasive procedure, it carries certain risks like any other aortic aneurysm repair method. Understanding these risks helps patients prepare and manage expectations during recovery.

Common complications include:

Endoleak: Blood may continue to leak into the aneurysm sac despite the stent graft.
Stent graft migration: Movement of the graft over time may require a secondary procedure.
Spinal cord injury: Rare but serious, this can lead to weakness or paralysis.
Kidney failure: Occurs in a small percentage of patients due to contrast dye used in imaging.
Infection or bleeding: At the access site in the groin or within the aorta.

The rate of spinal cord injury after TEVAR ranges from 2% to 10%, depending on the length of the covered aorta and other health factors. Similarly, kidney failure occurs in about 4% to 9% of cases, particularly among patients with pre-existing renal issues.

Common Risks and Estimated Occurrence Rate After TEVAR

Complication	Estimated Rate
Endoleak	10-15%
Graft migration	2-5%
Spinal cord injury	2-10%
Kidney failure	4-9%
Infection/bleeding	2-6%

Some complications may show up later. For example, aneurysm growth or aneurysm sac pressurization due to endoleak needs regular follow-up imaging. Endovascular stent graft repair does not eliminate the need for long-term surveillance. CT angiography at regular intervals helps detect changes early.

In cases where the anatomy is not suitable or if branching arteries are involved, a fenestrated endovascular aneurysm repair (FEVAR) might be needed. This can carry its own risks due to more complex planning.

Costs for secondary procedures or unexpected complications can increase the overall expense. TEVAR costs may rise if additional imaging, intensive care, or extended hospitalization is required. All costs are approximate and can vary depending on hospital policies, patient condition, and type of stent graft used.

Recovery After TEVAR

Recovery after TEVAR is generally shorter than open surgical repair. Most patients leave the hospital within 1 to 3 days and resume normal activities within two weeks. However, full recovery can take longer if complications occur.

Immediately after surgery:

Patients are observed in a high-dependency unit.
Blood pressure, urine output, and blood flow through the stent graft are closely monitored.
Pain is controlled with medications.

First few weeks:

Avoid heavy lifting and strenuous activity.
Resume light walking to improve blood circulation.
Take prescribed medications to manage blood pressure.
Schedule follow-up appointments for CT angiography.

The risk of delayed endoleak, stent graft migration, and aneurysm expansion requires continuous monitoring. Long-term success depends on regular follow-up and blood pressure control.

Recovery Timeline After TEVAR

Phase	Activities and Expectations
Day 0-3	Hospital stay, pain control, initial imaging
Week 1	Discharge, light walking, medication adherence
Week 2-4	Resume office work, avoid lifting
Month 1-6	Follow-up scans, check for endoleaks
Beyond 6 months	Long-term surveillance every 6-12 months

Some patients may experience groin swelling or mild pain at the catheter entry site. In rare cases, delayed bleeding or clotting in the femoral arteries may need attention. Early symptoms like leg weakness, changes in urine output, or severe abdominal pain should be reported to a vascular surgeon immediately.

Endovascular techniques like TEVAR and EVAR offer quicker recovery, but patient outcomes still depend on the anatomy of the abdominal aorta or thoracic aorta, as well as factors like diabetes, smoking, and age. Maintaining lifestyle changes and attending scheduled follow-ups is critical.

Long-Term Outlook and Life After TEVAR

Most patients do well after TEVAR, but it requires a lifetime of monitoring. The risk of aneurysm rupture is significantly reduced after the stent graft is in place, yet issues like endoleak or graft wear can still occur.

Patients must:

Attend imaging checkups to confirm the aneurysm sac is shrinking.
Maintain good blood pressure levels.
Avoid smoking and follow dietary advice.

Over the years, new techniques such as fenestrated stent grafts and branched stent systems have improved long-term durability, especially in cases where the aneurysm involves the visceral arteries or proximal aortic neck.

The success rate of TEVAR is high when performed under proper anatomical conditions. In clinical studies, the one-year survival rate ranges from 85% to 90%. The re-intervention rate in the first five years ranges from 10% to 20%.

Life after TEVAR can be normal with minor changes in activity. Most patients return to routine life, with periodic scans and prescriptions. In some cases, ongoing cardiovascular surgery or additional endovascular procedures may be needed.

TEVAR for Specific Populations

TEVAR is not a one-size-fits-all solution. The effectiveness and risks vary depending on the patient’s age, overall health, and specific anatomy of the aorta. Certain groups require special consideration before recommending TEVAR or other endovascular aneurysm repair methods.

1. Elderly Patients

TEVAR is often preferred in elderly patients with thoracic aortic aneurysms due to its minimally invasive nature. Recovery is quicker, and the risk of complications from open surgery is higher in this group. However, long-term monitoring is essential as elderly patients may have reduced kidney function and other comorbidities.

2. Patients with Chronic Kidney Disease

TEVAR involves contrast dyes that can worsen kidney function. In such patients, the vascular surgeon may modify imaging or take preventive measures to protect the kidneys.

3. Emergency Cases (Ruptured Aneurysm)

TEVAR is often used for ruptured thoracic or abdominal aortic aneurysms because it can be performed faster than open surgery. Time is critical when dealing with an aneurysm rupture, especially when there is major blood loss.

4. Patients with Complex Aortic Anatomy

Those with short proximal aortic neck, involvement of renal arteries, or branching arteries may need fenestrated endovascular aneurysm repair (FEVAR). This customised stent graft procedure is more complex and requires planning.

5. Patients with Prior Aortic Surgery or Grafts

TEVAR can be used for secondary repairs or graft complications. Previous cardiovascular surgery does not rule out TEVAR, but the surgeon must carefully assess the vascular anatomy.

TEVAR Considerations by Population TypeIn each case, the treatment team evaluates the aortic lumen, aneurysm sac, and nearby arteries using CT angiography. The expandable stent graft must fit precisely, especially if the aneurysm involves visceral arteries or extends toward the aortic arch.

Choosing a Specialist and Treatment Center

Selecting the right hospital and vascular surgery team can impact the outcome of TEVAR, EVAR, or any endovascular treatment. Patients must consider both medical expertise and the hospital’s ability to manage complex aortic disease.

1. Experience of the Vascular Surgeon

Choose a vascular surgeon experienced in TEVAR, EVAR, and fenestrated stent graft procedures. Complex aneurysms involving internal iliac artery, external iliac artery, or thoraco abdominal aortic aneurysms need an expert.

2. Multidisciplinary Team

Hospitals with a dedicated team of interventional radiologists, anesthesiologists, nephrologists, and critical care specialists are better equipped to manage complications such as blood transfusion needs, kidney failure, and spinal cord injury.

3. Advanced Imaging Technology

Modern facilities should offer high-resolution CT angiography and intraoperative imaging tools for accurate stent graft delivery and follow-up.

4. Post-operative Monitoring and ICU Support

Endovascular aortic repair requires strong post-op care, especially in patients with abdominal aorta complications or aneurysm rupture.

5. Availability of Endovascular Inventory

A center that stocks a wide range of stent graft sizes, including fenestrated graft and branched systems, can handle complex vascular anatomy and reduce surgical delays.

Costs for TEVAR vary. Estimated costs in India may range between INR 4,00,000 and INR 9,00,000. This estimate can change depending on the type of graft used, ICU stay, additional endovascular procedures, or patient comorbidities.

Cost Breakdown of TEVAR and Related Procedures

The cost of TEVAR can vary widely depending on the hospital, patient condition, and the complexity of the aneurysm repair. As a minimally invasive procedure, TEVAR typically involves lower hospital stays than open surgery. However, the total cost depends on multiple components.

1. Pre-operative Expenses

This includes CT angiography, blood tests, and consultations. Imaging is key to evaluating the aortic wall, proximal aortic neck, and surrounding blood vessels. These costs can range between INR 15,000 to INR 50,000.

2. Stent Graft and Procedure Costs

The stent graft aorta devices used in TEVAR or EVAR procedures are expensive and vary based on the brand, complexity, and whether fenestrated grafts are needed. The graft alone can cost INR 2,50,000 to INR 5,50,000. Procedure charges, including anaesthesia and vascular surgeon fee, add another INR 1,00,000 to INR 2,00,000.

3. Hospital Stay and ICU

A hospital stay is usually 2–4 days, including 1 ICU stay. Room type, city, and ICU charges will influence the cost. ICU rates may range between INR 15,000 and INR 25,000 per day.

4. Post-operative Medications and Imaging

Post-procedure care involves medications for blood pressure, anti-clotting agents, and repeat imaging. The first-year follow-up costs can range between INR 40,000 to INR 75,000.

Estimated TEVAR Cost Breakdown (INR)

Component	Estimated Cost Range
Pre-operative diagnostics	15,000 – 50,000
Stent graft & delivery system	2,50,000 – 5,50,000
Procedure & surgical team	1,00,000 – 2,00,000
ICU and hospital room	40,000 – 1,00,000
Post-op medication and imaging	40,000 – 75,000
Total Estimated Cost	4,00,000 – 9,00,000

These estimates may vary depending on patient complications, blood transfusion requirements, length of hospital stay, and whether complex endovascular repair like FEVAR is used.

Understanding the Anatomy Involved in TEVAR

TEVAR is performed without open chest surgery by guiding a stent graft through the arteries to repair a thoracic aortic aneurysm. Understanding the vascular structure is essential for safe placement and long-term success. The aorta carries blood from the heart to the rest of the body.

Aneurysms form when part of the aortic wall weakens. For TEVAR to work, the aneurysm must be reachable via arteries, and the surrounding blood vessels must be healthy enough to anchor the stent.

In some cases, especially when branching arteries are involved or the anatomy is irregular, doctors may use fenestrated endovascular aneurysm repair (FEVAR) instead. The patient’s exact anatomy, including the aortic arch, proximal aortic neck, and access points like the femoral arterie, will affect planning, device selection, and outcomes.

1. Thoracic Aorta

This is the chest portion of the aorta, running from the heart to the diaphragm. It is the main focus of TEVAR. Damage or weakening here can lead to thoracic aortic aneurysm, often detected through imaging like CT angiography. This area must be accurately mapped to guide stent graft placement.

2. Proximal and Distal Landing Zones

These are the healthy portions of the aorta before and after the aneurysm. The stent graft anchors in these zones to seal off the aneurysm sac and maintain blood flow. If these landing zones are too short or diseased, a standard TEVAR may not work, requiring FEVAR instead.

3. Branching Arteries

Arteries branching from the thoracic aorta include those leading to the kidneys, digestive organs, and spinal cord. These include the renal, visceral, and iliac arteries. Care is taken during TEVAR to avoid blocking these, as this can cause complications. Special stent designs help protect blood flow to these areas.

4. Access Points

The femoral arteries are the usual entry point for TEVAR. These arteries are located in the groin and allow surgeons to insert and navigate the stent graft. If these vessels are blocked or too narrow, alternatives like the external iliac artery or direct access to the abdominal aorta may be used.

5. Aneurysm Shape and Size

Aneurysms can be fusiform (tube-shaped) or saccular (balloon-shaped). TEVAR works best when the aneurysm’s shape and size allow proper sealing. Irregular or large aneurysms may need fenestrated stent grafts. Surgeons also assess how far the aneurysm extends and whether it involves branching arteries.

Understanding vascular anatomy is critical in determining the suitability of a patient for TEVAR, EVAR surgery, or fenestrated endovascular aneurysm repair.

Preparing for TEVAR: Patient Checklist and Pre-Procedure Planning

A successful TEVAR procedure depends on proper planning and preparation. Patients should follow all pre-op steps as guided by their vascular surgeon.

1. Diagnostic Imaging

CT angiography is required to plan stent graft delivery. It helps locate the aneurysm sac, assess the size, and determine if the aneurysm involves visceral or branching arteries.

2. Medical Clearance

Cardiac evaluation, blood pressure control, and kidney function tests are necessary. Patients with abdominal aortic aneurysms or diabetes may need tailored care.

3. Medication Review

Doctors may stop or adjust medications like blood thinners. You must share all prescriptions, including those for hypertension or cholesterol.

4. Lifestyle Preparation

Stop smoking at least two weeks before surgery. Avoid alcohol and follow a low-sodium diet to control blood pressure. Arrange for post-op care at home.

5. Admission Day Preparation

Do not eat 8 hours before surgery. Bring all reports, insurance documents, and wear comfortable clothing.

This planning helps reduce risk and ensures better outcomes for TEVAR and related endovascular procedures.

Advanced Aneurysm Treatment Starts at SRM Global Hospitals.

Thoracic Endovascular Aneurysm Repair (TEVAR) is now a mainstay for treating thoracic aortic aneurysms and related aortic disease. Its minimally invasive approach makes it safer than traditional open surgery for many patients, including elderly individuals or those with chronic conditions.

Choosing between TEVAR, EVAR, or FEVAR depends on the aneurysm’s size, shape, and involvement of surrounding blood vessels. Vascular anatomy, especially the aortic arch, proximal aortic neck, and branching arteries, helps guide the treatment plan. Techniques like fenestrated endovascular aneurysm repair allow repair even when visceral arteries are close to the aneurysm.

Endovascular therapy offers better recovery, but long-term success relies on patient monitoring, imaging, and blood pressure control. Imaging follow-up is important every 6 to 12 months to detect changes in the aneurysm sac, stent graft position, or blood flow abnormalities. Discussing options with a qualified centre ensures better planning and results.

Consult SRM Global Hospitals Today! If you or a family member has an aortic aneurysm, consult the experienced team at SRM Global Hospitals. Our vascular surgery experts use advanced endovascular techniques like TEVAR, EVAR, and FEVAR to safely treat thoracic and abdominal aneurysms.

Schedule your consultation today and explore safe, modern treatment options.

FAQs

1. Is TEVAR safe for elderly patients?

Yes, TEVAR is generally considered safer than open surgery in elderly patients. The smaller incisions, less blood loss, and faster recovery reduce hospital risks in patients over 70.

2. How long do stent grafts last after TEVAR?

Stent grafts are designed to last many years. However, long-term monitoring is needed to check for endoleaks, aneurysm sac changes, or stent wear, especially in younger patients.

3. Is TEVAR better than open surgery?

TEVAR is less invasive and has a shorter recovery time, but it may not be suitable for all patients. The choice depends on aortic wall anatomy, health status, and aneurysm size or location.

4. What happens if the stent graft moves or leaks?

Additional endovascular repair may be required if the stent graft migrates or leaks. Early detection through regular imaging helps avoid emergency surgery.

5. Does insurance cover TEVAR and EVAR?

Many private insurance providers and government schemes cover endovascular aneurysm repair. However, coverage can vary depending on the hospital and individual policy terms.