Thoracic Aortic Endografts: Past, Present, and Future

Thoracic endovascular aortic repair (TEVAR) has become first-line therapy for a wide range of thoracic aortic pathologies including traumatic thoracic aortic injury, type B aortic dissection, intramural thoracic aortic hematoma, and penetrating aortic ulcers. This study aims to analyze the progress made of thoracic stent graft devices, review the current Food and Drug Administration (FDA)-approved devices, and discuss the future technological advances.

In this paper, we will review the history of TEVAR and the development of the first iteration of devices. We will discuss the four currently available TEVAR devices, the GORE® TAG® (W. L. Gore and Associates, Flagstaff, Arizona), Medtronic Navion™ (Medtronic plc, Santa Rosa, California), Bolton RELAY® (Terumo Aortic, Sunrise, Florida), and the Zenith® Alpha™ Thoracic and the Zenith® Dissection Stent Graft (Cook Medical, Bloomington, Indiana), and the features and applications of each. Finally, future advancements in TEVAR technology and grafts currently under trial will be reviewed.

The first generation of TEVAR grafts had several limitations including large delivery systems, the need for rapid pacing for accurate deployment, wind socking during deployment, and graft migration. The current available TEVAR grafts have novel features to address these prior pitfalls. The GORE® TAG® is initially deployed 50% with subsequent room for adjustment to increase accuracy; the Medtronic Navion™ and Bolton RELAY® are available in low-profile delivery systems; and the Cook Zenith® Alpha™ now has an open cell petticoat specific for use in dissections extending to the visceral abdominal aorta. The current generation of TEVAR devices have broadened the application of TEVAR and reduced the anatomic limitations previously encountered.

TEVAR has evolved to overcome technical challenges and offer expanded applicability to different types of thoracic aortic pathologies and enhanced accuracy of deployment.