 Introduction/Background Since the first thoracic aorta endograft device was approved by the FDA in 2005, thoracic endovascular aortic repair (TEVAR) has undergone rapid evolution and is now applied to a range of aortic pathologies, including trauma, aneurysm, dissections, intramural hematoma (IMH), penetrating atherosclerotic ulcer (PAU), and even persistent congenital malformations such as aortic co-arctation [1,2]. TEVAR has also been used as a bridge treatment before open repair in patients with aortic infections who develop circulatory collapse or fistulization to adjacent structures [3,4]. Compared with open surgical repair, TEVAR has demonstrated favorable perioperative morbidity and mortality data for many forms of thoracic aorta pathology [5]. TEVAR also allows for intervention in patients with more extensive comorbidities that would otherwise preclude open surgical repair [6]. In certain patient groups, including variant anatomy such as aberrant right subclavian artery with aneurysmal degeneration of the vessel origin, hybrid open and endovascular procedures are performed wherein affected visceral branch vessels are surgically revascularized with concomitant or staged endovascular exclusion of the primary aortic pathology [7-9]. Thoracic aortic aneurysms are defined as permanent dilation of the thoracic aorta by more than 2 SDs over the mean. Based on population studies, the thoracic aorta is generally considered aneurysmal at 4 cm. Up to one-third of thoracic aortic aneurysms extend into the abdominal aorta, increasing complexity of endovascular or surgical repair [10]. Intervention is indicated when aneurysm diameter exceeds 5.5 cm or demonstrates rapid growth [10]. More conservative thresholds are implemented in patients with underlying connective tissue disorders or a bicuspid aortic valve.
Thoracic Aortic Aneurysm or Dissection Treatment Planning and Follow Up.  Introduction/Background Since the first thoracic aorta endograft device was approved by the FDA in 2005, thoracic endovascular aortic repair (TEVAR) has undergone rapid evolution and is now applied to a range of aortic pathologies, including trauma, aneurysm, dissections, intramural hematoma (IMH), penetrating atherosclerotic ulcer (PAU), and even persistent congenital malformations such as aortic co-arctation [1,2]. TEVAR has also been used as a bridge treatment before open repair in patients with aortic infections who develop circulatory collapse or fistulization to adjacent structures [3,4]. Compared with open surgical repair, TEVAR has demonstrated favorable perioperative morbidity and mortality data for many forms of thoracic aorta pathology [5]. TEVAR also allows for intervention in patients with more extensive comorbidities that would otherwise preclude open surgical repair [6]. In certain patient groups, including variant anatomy such as aberrant right subclavian artery with aneurysmal degeneration of the vessel origin, hybrid open and endovascular procedures are performed wherein affected visceral branch vessels are surgically revascularized with concomitant or staged endovascular exclusion of the primary aortic pathology [7-9]. Thoracic aortic aneurysms are defined as permanent dilation of the thoracic aorta by more than 2 SDs over the mean. Based on population studies, the thoracic aorta is generally considered aneurysmal at 4 cm. Up to one-third of thoracic aortic aneurysms extend into the abdominal aorta, increasing complexity of endovascular or surgical repair [10]. Intervention is indicated when aneurysm diameter exceeds 5.5 cm or demonstrates rapid growth [10]. More conservative thresholds are implemented in patients with underlying connective tissue disorders or a bicuspid aortic valve.