Thoracic endovascular aortic repair (TEVAR) is now the treatment of choice for most diseases of the thoracic aorta. Current evidence and guidelines for practice are based on pooled analysis of data that are of variable quality. Questions remain about the applicability of TEVAR to different pathologies, peri-procedural neurological complications, the subsequent durability of the procedure and mid-term survival of patients. Methods and Results A systematic review of the literature was performed to describe the incidence of peri-operative and mid-term adverse events following TEVAR. For the main investigation, data from five phase IV trials was combined with that from St George's Vascular Institute to form a composite dataset of 1010 patients that underwent TEVAR from 2002-2010. A high rate of mid-term all cause mortality was observed in patients treated for thoracic aortic aneurysm, with less than 60% of those treated living beyond 5 years. Factors predicting neurological complications were determined using logistic regression modelling. Coverage of the left subclavian artery was the most important predictor of post-operative stroke, specifically in posterior vascular territories. Patients undergoing elective repair of thoracic aortic aneurysms were stratified into those at high, intermediate and low risk of a death wi!hin five years using regression models based on pre-operative factors. Those at high and low risk of aortic re-intervention were similarly identified. The models were validated externally using a dataset obtained from the United States. Conclusions Post-operative outcomes following TEVAR are partly dependent on presenting pathology, especially with regards to mid-term all-cause death. Coverage of the left subclavian artery is one of the few potentailly modifiable risk factors for stroke. Patients can risk-stratified according to the risk of midterm all cause death following TEVAR, and careful consideration should be given before treating patients who may not benefit in terms of overall life expectency.

Aortic aneurysm and dissections are potentially life threatening conditions. The advent of endovascular aortic repair (EVAR) and thoracic endovascular aortic repair (TEVAR) has reduced perioperative mortality and morbidity and are now established therapy methods for treatment of aortic disease. Adequate pre- and intraoperative imaging is important for optimal results in endovascular procedures. However, the standard use of CT and angiography may not always be sufficient to provide necessary information required for treatment, and complementary techniques are warranted in selected cases. TEVAR in acute complicated type B aortic dissections is proven effective in several reports, but long-term clinical outcome and aortic remodelling are still not fully evaluated. Intravascular phased array imaging (IPAI) was used in patients undergoing EVAR and TEVAR for aortic aneurysm and dissection. The combined information from IPAI and fluoroscopy allowed exact positioning of the stent graft. The colour Doppler function facilitated detection of blood-flow in relevant arteries during and after the procedures, and it also facilitated control of ceased flow in excluded false lumens or aneurysms. Clinical early and long-term results after TEVAR for acute complicated type B aortic dissection were investigated in all patients treated between 1999 and 2009 at UppsalaUniversityHospital. Results were favourable regarding survival and permanent neurological complications. Long-term follow-up of aortic morphological changes in the same patient group showed overall significant reduction of aortic and false lumen diameters, and an increase of true lumen diameter. Total thrombosis of the false lumen occured more often in patients with DeBakey IIIa aortic dissection, than in IIIb. In conclusion, IPAI may be a complementary tool to traditional imaging modalities in EVAR and TEVAR in selected cases. Long-term clinical outcome is excellent with favourable aortic remodeling after TEVAR in patients with acute complicated type B aortic dissection.