Results and clinical consequences of trials on thoracic endografting

Thoracic endovascular repair (TEVR) has developed from endovascular treatment of infrarenal aortic aneurysms, and is now considered first-line treatment for a variety of thoracic aortic pathologies. In contrast to infrarenal repair, there are no large randomized controlled trials to underpin this change in practice, and most of the existing data are from smaller trials designed to evaluate the safety of a particular device. The aim of this review was to describe these studies with respect to perioperative adverse events, occurrence of device failure, mid-term aortic death, mid-term overall survival and freedom from aortic reintervention. The implications of these 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, and the results of TEVR applied to particular pathology groups is discussed.