Thoracic Endovascular Aortic Repair (TEVAR) & Endovascular Repair (EVAR)
Key takeaways
Definition: TEVAR stands for Thoracic Endovascular Aortic Repair. It is a minimally invasive, catheter-based surgery. It is used to repair a damaged or weakened section of the aorta inside your chest.
How it Works: Instead of opening the chest, surgeons use small incisions under the arm and/or groin to slide a compressed, fabric-covered metal tube (stent graft) into the aorta. Once open, it realigns the weakened blood vessel and prevents the aneurysm from rupturing.
Conditions Treated: TEVAR is the gold standard for repairing thoracic aortic aneurysms (TAAs), Type B aortic dissections (tears) and traumatic aortic injuries.
Key Benefits: Because it avoids a major open-chest incision, TEVAR significantly reduces pain, shortens hospital stays and offers a much faster recovery than traditional open surgery.
Lifelong Tracking: Patients who undergo a TEVAR procedure require ongoing, long-term follow-up with regular CT scans to ensure the stent graft remains in place.
What is endovascular repair?
Traditional open aortic surgery requires a large incision to fully open the chest or abdomen so a cardiovascular surgeon can manually replace a damaged blood vessel. While highly effective, this method requires a long and demanding recovery process.
Endovascular repair is a modern, minimally invasive alternative to open aortic surgery. "Endovascular" means the surgery is performed entirely from the inside of your blood vessels. Instead of making large incisions, specialists use advanced X-ray imaging to guide long, thin, flexible tubes called catheters directly through your arterial system to complete the repair.
When an endovascular repair is performed in the abdominal region, it is called EVAR (Endovascular Aortic Repair). When it is performed higher up in the chest or the thoracic region, it is called TEVAR.
What is TEVAR?
TEVAR is a specialized type of endovascular repair that is specifically for the thoracic aorta—the main blood highway passing through your chest cavity.
During a TEVAR procedure, a stent graft is used to reinforce the blood vessel. A stent graft is a durable fabric tube supported by a metal mesh framework. The graft acts as a synthetic liner that covers the weak or torn section of your aorta. This redirects blood flow safely through the tube and relieves dangerous pressure on the damaged artery wall. Over time, the ballooning segment of the aorta typically shrinks toward its normal size.
Who is TEVAR for, and what conditions are treated by TEVAR?
Your vascular or cardiothoracic surgeon may recommend a TEVAR procedure if you are diagnosed with a severe, life-threatening condition affecting your thoracic aorta. The most common conditions include:
Thoracic Aortic Aneurysms (TAAs): A condition where the wall of the chest aorta becomes weak and bulges out like a balloon. TEVAR is typically recommended when a TAA reaches 5.5 cm or larger to prevent it from bursting. The threshold is 4.5 cm in patients with connective tissue disorders.
Aortic Dissections (Stanford Type B/Debakey Type III): This happens when a tear develops in the inner layer of the descending aorta. This allows blood to rush through the tears of the artery wall. TEVAR is used to seal the entry tear and restore normal blood flow.
Traumatic Aortic Injuries or Transections: High-impact chest trauma from serious car accidents or severe falls can cause the aorta to tear or rupture. Severe tears require immediate surgery, and TEVAR is the primary method used to quickly save these patients' lives.
How the TEVAR procedure works
Before the procedure
To ensure TEVAR surgery goes smoothly, you will follow a strict preparation protocol:
Fasting Rules: You can enjoy a normal dinner the evening before your surgery, but you must not eat or drink anything (including water, gum or hard candy) after midnight.
Medication Review: Bring an exact list of your current medications and dosages. If you take blood thinners (such as Warfarin, Coumadin, Plavix or Aspirin), your doctor will instruct you to stop taking them for a specific period before surgery to reduce the risk of bleeding.
Infection Prevention: You will be given a specialized antibacterial soap to use the day before your surgery. This significantly reduces bacteria on your skin and lowers infection risk.
Valuables: For your safety, leave jewelry, rings and electronics at home. You can wear your glasses, contacts or hearing aids right up until surgery to communicate easily with your care team.
During the procedure
TEVAR is performed in a specialized operating room under general anesthesia. You will be completely asleep.
Groin Access: The surgeon makes small incisions in your right and left groin to access the femoral arteries, which connect directly up to the aorta.
Spinal Protection: Depending on your specific case, a temporary spinal drain may be placed in your lower back. This drain reduces spinal fluid pressure. This reduction helps maintain steady blood flow to your spinal cord. This, in turn, prevents spinal cord ischemia (a rare complication that can cause paralysis).
Guidance and Visualization: The surgeon passes wires and catheters through the groin incisions up into the chest. A safe contrast dye is injected, and live X-rays are taken to provide the vascular surgeon with a clear, real-time visual map of your blood vessels.
Deploying the Stent: Under direct X-ray guidance, the compressed stent graft is led over the wires to the exact spot of the aneurysm or tear. The surgeon deploys the device. It then expands firmly against the healthy sections of your aorta, permanently sealing off the damaged segment.
TEVAR aftercare and recovery
Because TEVAR avoids major chest trauma, your recovery timeline is much shorter than that of open surgery. Most patients only spend one to three days in the hospital before returning home.
However, because endovascular stent grafts can occasionally shift, kink or develop minor leaks over time, TEVAR requires lifelong medical tracking. You will need routine follow-up imaging. This normally starts with a high-resolution CT scan one month after surgery. Then again, at six months and annually thereafter.
Frequently asked questions
What is the difference between EVAR and TEVAR?
The primary difference is the location of the treatment. EVAR (Endovascular Aortic Repair) is used to treat abdominal aortic aneurysms. TEVAR (Thoracic Endovascular Aortic Repair) uses the same minimally invasive catheter concepts but is specialized for treating conditions higher in the chest.
Why might I need a spinal drain during a TEVAR procedure?
The thoracic aorta provides critical blood flow to the spinal cord. When a stent graft is placed in the chest, it can temporarily reduce blood flow to the spine by covering a segment of the aorta. To protect you, a spinal drain may be used to lower fluid pressure around the spinal cord. This allows blood to flow more freely into the area, significantly reducing the risk of a rare but serious complication called spinal cord ischemia, which can lead to paralysis.
What happens if I accidentally eat or drink something after midnight before my surgery?
If you accidentally eat food or drink liquids after midnight, you must notify your surgical team immediately upon arrival. For your safety under general anesthesia, your stomach must be completely empty to prevent serious complications like aspiration. If necessary, your surgery may be delayed or rescheduled for later in the day.
Is a TEVAR procedure a permanent cure?
While TEVAR permanently seals off the damaged section of the aorta, it requires continuous lifelong surveillance. Because the stent graft is anchored within a living, changing blood vessel, routine CT scans are required to verify that the device hasn't moved and that no blood is leaking around its edges.
What happens if a patient needs an emergency TEVAR but is full or taking blood thinners?
In an extreme trauma emergency, such as an aortic tear from a car crash or a major fall, there is no time to fast or stop medications. The emergency trauma and anesthesia teams work under immediate, life-saving protocols. These are designed to bypass these normal rules safely:
Protecting a Full Stomach: To completely remove the risk of anything in the stomach entering the lungs while under general anesthesia, the anesthesia team performs a high-speed intubation technique called Rapid Sequence Induction (RSI). This allows them to safely place and seal a protective breathing tube in the patient's airway in under 60 seconds.
Reversing Blood Thinners: If a patient is taking blood thinners, the medical team immediately gives powerful intravenous reversal agents. These then neutralize the medication and restore the blood's natural clotting ability within minutes.
Emergency Blood Transfusions: The hospital's blood bank will be accessed immediately for a massive transfusion protocol. This involves pumping universal Type O-negative blood, plasma and platelets into the patient. This helps to keep their blood pressure stable and force clotting.
Because TEVAR is a minimally invasive procedure performed entirely inside the blood vessel, a vascular surgeon can normally guide the catheter and deploy the stent graft to seal the tear in less than 30 minutes. This speed and fact that there are no chest incisions make TEVAR the best life-saving tool for a bleeding trauma patient with an aortic tear or transection.
Why choose the UF Health Aortic Disease Center?
The UF Health Aortic Disease Center is a national and international leader in hybrid endovascular surgery and minimally invasive aortic care. Our multidisciplinary team combines the specialized expertise of vascular surgeons, cardiothoracic surgeons and advanced interventional radiologists. Because we are a high-volume academic research institution, our specialists regularly perform highly advanced catheter-based techniques, such as custom fenestrated grafts for complex arch repairs, providing exceptional outcomes and life-saving care that smaller hospital systems simply cannot replicate.
To find a provider, explore our specialized locations, or schedule an appointment, please contact the UF Health Aortic Disease Center by calling (352) 273-5494.
This entry was written by Gabrielle Massari, Marketing Content Writer, and reviewed for accuracy by Eric Jeng, MD. Generative AI was leveraged as part of the content creation process.