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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Anum Ijaz M.B.B.S., M.D.[2]

Endovascular Aortic Aneurysm Repair

Overview

Endovascular aortic aneurysm repair encompasses a family of catheter-based techniques that exclude aortic aneurysms and treat acute aortic syndromes by deploying stent grafts within the aortic lumen. The principal variants are:

  • EVAR (endovascular aneurysm repair): infrarenal abdominal aortic aneurysm (AAA)
  • TEVAR (thoracic endovascular aortic repair): descending thoracic aortic aneurysm (TAA) and acute aortic syndromes
  • FEVAR / F/BEVAR (fenestrated and/or branched endovascular aortic repair): juxtarenal, pararenal, and thoracoabdominal aortic aneurysms (TAAA), using custom-made or off-the-shelf devices with fenestrations or directional branches to preserve visceral and renal perfusion

EVAR is the dominant repair strategy for AAA in the United States, accounting for approximately 80% of elective AAA repairs.[1] Randomized trials consistently demonstrate lower perioperative mortality with EVAR than with open surgical repair (OSR), but this early advantage converges by 2–3 years with no long-term all-cause survival difference.[2][3] Lifelong imaging surveillance is mandatory after endovascular repair.[4][1]

Historical Perspective

  • 1987: Nikolai Volodos performed the first endovascular aortic repair (Kharkov, Soviet Union) using a self-fixing synthetic prosthesis for a traumatic thoracic aortic aneurysm; published 1988.
  • 1991: Juan Parodi performed the first transfemoral endovascular AAA repair; Michael Dake performed the first transluminal placement of an endovascular stent graft for descending TAA.
  • 1999–2008: Landmark randomized controlled trials (EVAR-1, DREAM, OVER, ACE) established the evidence base comparing EVAR with OSR for infrarenal AAA.[5]
  • 2005–2010: INSTEAD and ADSORB evaluated TEVAR for uncomplicated type B aortic dissection (TBAD).[6][7]
  • 2010s–present: FDA approval and expanded use of fenestrated/branched endografts for complex aortic aneurysms; increasing role of TEVAR in uncomplicated TBAD with high-risk features.[8][2]

Indications and Size Thresholds

1. Type B Aortic Dissection

  • Uncomplicated acute TBAD: medical therapy is initial management (COR 1, LOE B-NR). TEVAR may be considered (COR 2b, LOE B-R) with high-risk anatomic features.[9][7]
  • Complicated acute TBAD (rupture, malperfusion): intervention recommended (COR 1); TEVAR preferred over open repair when anatomy is suitable (COR 1 for rupture; COR 2a for other complications).[9]

High-risk features in uncomplicated TBAD that may warrant early TEVAR:[7][10][11]

  • Total aortic diameter >40 mm (thresholds differ across sources: the 2024 EACTS/STS and 2022 STS/AATS guidelines use >40 mm, whereas the Vilacosta JACC 2021 state-of-the-art review uses >44 mm)[11][7][10]
  • False lumen diameter >22 mm
  • Large proximal entry tear, especially on the lesser curvature
  • Refractory pain or refractory hypertension
  • Bloody pleural effusion
  • Imaging evidence of malperfusion

2. Ruptured AAA

The Society for Vascular Surgery (SVS) recommends EVAR over OSR for ruptured abdominal aortic aneurysm when anatomy is amenable (Grade 1-C).[5] Propensity-matched Vascular Quality Initiative analyses demonstrate 30-day mortality of 18%–21% for rEVAR versus 32%–34% for rOSR (OR 2.0; 95% CI 1.6–2.7), with sustained benefit at 1 year.[9][12][13]

3. Guideline-based thresholds for repair (2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease)

Segment Threshold / indication COR / LOE
Unruptured infrarenal AAA ≥5.5 cm in men; ≥5.0 cm in women 1 / A
Symptomatic AAA Symptoms attributable to the aneurysm 1 / B-NR
Saccular AAA or growth ≥0.5 cm in 6 months Repair may be reasonable 2b / C-LD
Intact descending TAA ≥5.5 cm 1
Descending TAA, no connective tissue disorder, suitable anatomy TEVAR recommended over open surgery 1 / B-NR
TAAA ≥6.0 cm 1 / B-NR
TAAA, experienced surgeons in a Multidisciplinary Aortic Team ≥5.5 cm reasonable 2a
Abbreviations: AAA = abdominal aortic aneurysm; ACC/AHA = American College of Cardiology/American Heart Association; COR = class of recommendation; LOE = level of evidence; TAA = thoracic aortic aneurysm; TAAA = thoracoabdominal aortic aneurysm; TEVAR = thoracic endovascular aortic repair.
LOE qualifiers: A = high-quality evidence from more than one randomized controlled trial or meta-analyses of high-quality RCTs; B-NR = moderate-quality evidence from one or more well-designed nonrandomized studies, observational studies, or registry studies; C-LD = randomized or nonrandomized studies with limitations of design or execution, or meta-analyses of such studies.
COR qualifiers: 1 = strong (benefit >>> risk); 2a = moderate (benefit >> risk); 2b = weak (benefit ≥ risk).

[9][14]

EVAR Versus Open Surgical Repair

Three landmark RCTs (EVAR-1, DREAM, OVER) and the ACE trial consistently show:[5][2][3]

  • 30-day operative mortality: lower with EVAR (0.2%–1.8%) than OSR (2.3%–4.6%); pooled OR 0.40.
  • Early survival advantage: perioperative benefit persists approximately 2–3 years.
  • Late outcomes: no long-term all-cause survival difference; higher late aneurysm-related mortality after EVAR.
  • Reintervention: more frequent after EVAR, though most are minor endovascular procedures; OSR is associated with more laparotomy-related complications (incisional hernia, bowel obstruction). Late open conversion after EVAR is reported in 1%–23% of patients.[5]

In the OVER trial, a subgroup analysis suggested improved long-term survival with EVAR in younger patients; this is a subgroup finding and should not be generalized. Registry data likewise indicate that the relative long-term benefit of EVAR versus OSR is age-dependent.[5][15][16]

Patient Selection

Per the 2022 ACC/AHA Guideline:[9]

  • Low-to-moderate operative risk with anatomy suitable for either approach: shared decision-making (COR 1, LOE A).
  • Adherence to the manufacturer's instructions for use (IFU) is recommended for elective EVAR (COR 1, LOE B-NR).
  • High perioperative risk: EVAR is reasonable to reduce 30-day morbidity and mortality (COR 2a, LOE B-NR).
  • Anatomy suitable for an FDA-approved fenestrated device: endovascular repair is reasonable over open repair (COR 2a, LOE B-NR).

Volume standards: SVS recommends EVAR be performed at centers completing ≥10 cases/year with documented perioperative mortality and conversion rates ≤2%.[5]

Patients with Marfan syndrome, Loeys-Dietz syndrome, or vascular Ehlers-Danlos syndrome generally require open repair because of progressive aortic disease and endograft failure.[9]

Anatomic Requirements and Device Selection

Successful EVAR requires adequate proximal and distal sealing zones — segments of nonaneurysmal, parallel-walled artery against which the stent graft can appose and seal.[2][17]

Most endografts dependent on infrarenal fixation require:[17]

  • Proximal neck length: ≥15 mm (some newer devices permit ≥10 mm)
  • Neck diameter: within the device-specific range specified in the IFU
  • Neck angulation: within device-specific IFU limits
  • Iliofemoral access: vessel diameter adequate for the delivery system per IFU

Hostile neck anatomy and EVAR performed outside IFU are independently associated with:[18][19]

  • Higher rates of type Ia completion endoleak (OR 1.6)
  • Increased perioperative mortality (OR 1.8)
  • Greater 1-year sac expansion and reintervention rates

Neck length and neck angulation are the most critical anatomic determinants. When hostile neck anatomy precludes standard EVAR within IFU, alternatives include fenestrated/branched devices, endoanchors, chimney techniques, or open repair.[19]

Procedural Technique

Standard EVAR

Performed in a hybrid operating room or angiography suite under fluoroscopic guidance, typically under general or regional anesthesia:[2]

  1. Vascular access: bilateral femoral access. Ultrasound-guided percutaneous access and closure is recommended over open cutdown in patients with suitable common femoral artery anatomy (COR 1, LOE B-R).[9]
  2. Guidewire and catheter placement: guidewires advanced into the thoracic aorta; diagnostic angiography identifies renal artery origins.
  3. Main body deployment: bifurcated main body deployed with the proximal seal zone just below the renal arteries, guided by angiography and/or intravascular ultrasound.
  4. Contralateral limb deployment: contralateral iliac limb deployed through the contralateral femoral access and docked into the main body.
  5. Completion angiography: confirms sac exclusion, absence of endoleak, and renal/iliac patency.

TEVAR

  • Landing zone planning: proximal and distal landing zones ≥2 cm in nonaneurysmal aorta.
  • Left subclavian artery (LSA) management: when proximal landing in zone 2 is required, LSA revascularization is recommended before TEVAR to reduce spinal cord ischemia (COR 1, LOE B-NR).[9]
  • Access: preoperative CT angiography of the iliofemoral vessels is mandatory; alternative conduits (iliac conduit, direct aortic access) should be used when access is marginal (COR 1, LOE B-NR).[9]

Fenestrated and Branched EVAR (F/BEVAR)

F/BEVAR extends endovascular repair to juxtarenal, pararenal, and thoracoabdominal aneurysms by incorporating fenestrations or directional branches to maintain renal and visceral perfusion:[8][2]

  • Fenestrations: preferred for pararenal aneurysms, where the gap between the aortic graft and the branch vessel is small.
  • Directional branches: preferred for thoracoabdominal aneurysms, where a wider gap exists.
  • Prospective studies report elective 30-day mortality of 0.9%–4.4%, with 5-year freedom from aortic-related mortality of 89%–98%.[8][20]
  • A 2026 meta-analysis of 11,298 patients found F/BEVAR associated with lower 30-day mortality (OR 0.72; 95% CI 0.56–0.92) and lower acute kidney injury than OSR in propensity-matched studies, though reintervention was more frequent (HR 3.94).[21]

Iliac Branch Devices

When the aneurysm extends into the common iliac arteries, iliac branch devices preserve internal iliac artery perfusion, reducing buttock claudication, sexual dysfunction, ischemic colitis, and spinal cord ischemia compared with internal iliac artery occlusion.[22][23]

Hybrid Procedures and Aortic Arch Repair

Hybrid procedures combine limited open revascularization with endovascular stent graft deployment to extend the proximal or distal landing zone:

  • Carotid–subclavian bypass or transposition + zone 2 TEVAR for thoracic aneurysms extending into the proximal arch
  • Carotid–carotid bypass + zone 1 TEVAR for more extensive arch involvement
  • Visceral debranching + TEVAR for thoracoabdominal aneurysms in patients unfit for open repair or F/BEVAR

Branched and fenestrated arch endografts and chimney/snorkel techniques are progressively reducing the need for hybrid approaches, though these remain important in anatomically complex cases.[9]

Complications

Systemic

Myocardial infarction, congestive heart failure, arrhythmias, respiratory failure, acute kidney injury.

Access-site injury (dissection, thrombosis), atheroembolization, renal artery occlusion, ischemic colitis, groin hematoma/pseudoaneurysm, wound infection.

Endograft migration, component separation, limb thrombosis, limb kinking, stent fracture.

Postimplant Syndrome

Postimplant syndrome (PIS) — fever and leukocytosis without an infectious etiology — occurs in 14%–60% of EVAR patients; endograft composition may contribute.[5] Although traditionally regarded as benign and self-limited, a systematic review found PIS associated with higher 30-day mortality (0.6% vs 0%; P=0.03) and more major adverse cardiac events (5.8% vs 0.43%).[24][25] PIS should not be reflexively treated as graft infection, but it is not a wholly benign marker.

Spinal Cord Ischemia

Spinal cord ischemia (SCI) is a devastating complication, particularly after TEVAR and F/BEVAR. Risk factors:[26][27]

  • Extensive aortic coverage (>15 cm)
  • Prior aortic repair (EVAR or open)
  • LSA coverage without revascularization
  • Compromised hypogastric artery perfusion
  • Diseased or occluded vertebral arteries

Prevention is multimodal:[26][27]

  • Prophylactic cerebrospinal fluid drainage in high-risk cases (Grade 1, LOE B)
  • LSA revascularization when coverage is planned (COR 1, LOE B-NR)[9]
  • Staging of extensive aortic coverage
  • Maintenance of mean arterial pressure ≥80 mmHg
  • Preservation of hypogastric artery perfusion
  • Avoidance of perioperative anemia

Endoleaks

Endoleaks are the most common complication of EVAR, affecting approximately 30% of patients.[1]

Endoleak classification and management
Type Mechanism Management
Type I (Ia proximal, Ib distal) Attachment-site perigraft leak at the proximal or distal seal zone Rupture risk 7.5% at 2 years; requires intervention when identified
Type II Retrograde branch vessel flow (lumbar, inferior mesenteric, accessory renal); most common type (~50% of endoleaks); up to 90% resolve spontaneously or remain stable Rupture risk <1% at 4.8 years; observation is appropriate for most. The SVS recommends intervention with sac growth >5 mm (Level 2, Quality C), whereas the ESVS recommends intervention with sac growth >10 mm (Class IIa, Level C)
Type III Graft component separation or fabric defect Rupture risk 8.9% at 1 year; requires intervention when identified
Type IV Graft porosity; transient leak through intact graft material Uncommon and typically benign; observation
Type V (endotension) Sac enlargement without an identifiable endoleak on imaging Observation; consider intervention with progressive sac growth

[1][9]

Imaging Surveillance

After EVAR

Lifelong surveillance is mandatory.[4][9]

  • Baseline: contrast-enhanced CT angiography (CTA) and color duplex ultrasound (DUS) within 30 days of EVAR.
  • Endoleak or sac enlargement identified: repeat imaging at 6 months (Grade 2B).
  • No endoleak or sac enlargement: annual DUS (preferred), or CTA if DUS is not feasible (Grade 1B).
  • New endoleak, graft migration, or sac growth ≥5 mm on DUS: prompt contrast-enhanced CTA.
  • Every 5 years: non-contrast CT of the entire aorta after either OSR or EVAR (Grade 2C).

Triple-phase CTA (noncontrast, arterial, delayed venous) is the reference standard for endoleak detection and characterization.[28][1]

After TEVAR and F/BEVAR

CTA-based surveillance is required, as DUS cannot adequately image thoracic endografts or branch vessel stents. Intervals mirror EVAR protocols, with attention to endoleak, migration, and new or progressive aneurysmal disease; more frequent surveillance may be warranted after F/BEVAR given higher reintervention rates.[9][2][20]

Use in Aortic Dissection

Complicated Type B Aortic Dissection

TEVAR is the treatment of choice for complicated TBAD (rupture, malperfusion) with suitable anatomy.[9][7] An umbrella review and meta-analysis found short-term mortality of 2%–13.4% with TEVAR versus 4.5%–19% with OSR (RR 0.51; 95% CI 0.43–0.59), with fewer cardiac, pulmonary, renal, and bleeding complications.[29]

Endovascular techniques:

  • Primary entry tear coverage with a thoracic stent graft
  • PETTICOAT technique: proximal covered stent graft plus distal bare metal stent for complicated dissection with distal malperfusion[6]
  • Adjunctive branch vessel stenting for persistent malperfusion

Uncomplicated Type B Aortic Dissection

  • INSTEAD: no difference in 2-year all-cause mortality between TEVAR plus medical therapy and medical therapy alone. INSTEAD-XL (5-year follow-up) showed improved aorta-specific mortality with TEVAR (6.9% vs 19.3%; HR 0.35; P=0.04) and reduced disease progression (27% vs 46%).[6][7]
  • ADSORB: at 1 year, TEVAR produced superior aortic remodeling (57% vs 3%).[6]
  • Current US guidelines assign COR 2b for TEVAR in uncomplicated TBAD with high-risk features.[9][6]
  • Ongoing RCTs (IMPROVE-AD, SUNDAY, EARNEST) are expected to provide definitive evidence.[6]

Timing

Intervention in the subacute phase (beyond 24 hours up to 90 days) may reduce periprocedural complications while still achieving favorable aortic remodeling.[30][7] Miyairi and colleagues reported that hyperacute TEVAR carried substantially higher in-hospital mortality than TEVAR performed in the acute or subacute phases (14.9% vs 0% vs 2.8%), supporting deferral of intervention beyond the hyperacute window when the dissection is uncomplicated.[31][7]

Clinical Pearls and Common Pitfalls

  • EVAR reduces 30-day mortality by ~60% versus OSR (pooled OR 0.40), but the advantage is lost by 3 years, with no long-term all-cause survival difference.[3]
  • Endoleaks affect ~30% of EVAR patients; types I and III require intervention (rupture risk 7.5% at 2 years and 8.9% at 1 year, respectively), whereas type II carries <1% rupture risk at 4.8 years and warrants intervention only with sac growth. Treating all type II endoleaks aggressively is a common error.[1]
  • IFU adherence is a COR 1 recommendation; EVAR outside IFU carries 1.8× higher perioperative mortality and increased type Ia endoleak, sac expansion, and reintervention.[9][18][19]
  • Ultrasound-guided percutaneous femoral access with closure is a COR 1 (LOE B-R) recommendation over open cutdown in suitable common femoral artery anatomy.[9]
  • Neglecting LSA revascularization before zone 2 TEVAR increases spinal cord ischemia and stroke risk (COR 1 recommendation).[9][7]
  • For ruptured AAA with suitable anatomy, an endovascular-first strategy yields 30-day mortality of ~20% versus ~35% with open repair.[12][13]
  • INSTEAD-XL showed improved 5-year aorta-specific survival with TEVAR plus medical therapy (6.9% vs 19.3%) in uncomplicated TBAD, but US guidelines assign only COR 2b pending further RCT data; the 2024 EACTS/STS guidelines are more permissive (Class IIa).[6][9][11]
  • In uncomplicated TBAD, hyperacute TEVAR carries markedly higher in-hospital mortality than acute or subacute repair (14.9% vs 0% vs 2.8%).[31][7]
  • F/BEVAR is a viable option for complex aortic aneurysms (elective 30-day mortality 0.9%–4.4%), but reintervention is substantial (~40% freedom from reintervention at 5 years).[8][20]
  • Failure to maintain lifelong surveillance is a major pitfall; endoleaks can appear years after repair, and at minimum contrast-enhanced imaging every 5 years is recommended.[1]
  • Postimplant syndrome (fever, leukocytosis without infection) occurs in 14%–60% and should not be reflexively treated as graft infection, but it has been associated with higher 30-day mortality and cardiac events.[5][24]
  • Overlooking hypogastric artery preservation increases buttock claudication, sexual dysfunction, and spinal cord ischemia; iliac branch devices should be considered when feasible.[23]
  • Outcomes are volume-dependent; EVAR should be performed at centers with ≥10 cases/year and documented low complication rates.[5]

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Cifuentes S, Mendes BC, Tabiei A; et al. (2023). "Management of endoleaks after elective infrarenal aortic endovascular aneurysm repair: a review". JAMA Surgery. 158 (9): 965–973. doi:10.1001/jamasurg.2023.2934.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Schanzer A, Oderich GS (2021). "Management of abdominal aortic aneurysms". The New England Journal of Medicine. 385 (18): 1690–1698. doi:10.1056/NEJMcp2108504.
  3. ↑ 3.0 3.1 3.2 Powell JT, Sweeting MJ, Ulug P; et al. (2017). "Meta-analysis of individual-patient data from EVAR-1, DREAM, OVER and ACE trials comparing outcomes of endovascular or open repair for abdominal aortic aneurysm over 5 years". The British Journal of Surgery. 104 (3): 166–178. doi:10.1002/bjs.10430.
  4. ↑ 4.0 4.1 Rokosh RS, Wu WW, Schermerhorn M, Chaikof EL (2021). "Society for Vascular Surgery implementation of clinical practice guidelines for patients with an abdominal aortic aneurysm: postoperative surveillance after abdominal aortic aneurysm repair". Journal of Vascular Surgery. 74 (5): 1438–1439. doi:10.1016/j.jvs.2021.04.037.
  5. ↑ 5.0 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 Hensley SE, Upchurch GR (2022). "Repair of abdominal aortic aneurysms: JACC Focus Seminar, Part 1". Journal of the American College of Cardiology. 80 (8): 821–831. doi:10.1016/j.jacc.2022.04.066.
  6. ↑ 6.0 6.1 6.2 6.3 6.4 6.5 6.6 Mussa FF, Kougias P (2025). "Management of acute type B aortic dissection". The New England Journal of Medicine. 393 (9): 895–905. doi:10.1056/NEJMra2405257.
  7. ↑ 7.00 7.01 7.02 7.03 7.04 7.05 7.06 7.07 7.08 7.09 MacGillivray TE, Gleason TG, Patel HJ; et al. (2022). "The Society of Thoracic Surgeons/American Association for Thoracic Surgery clinical practice guidelines on the management of type B aortic dissection". The Annals of Thoracic Surgery. 113 (4): 1073–1092. doi:10.1016/j.athoracsur.2021.11.002.
  8. ↑ 8.0 8.1 8.2 8.3 Oderich GS, Tenorio ER, Mendes BC; et al. (2021). "Midterm outcomes of a prospective, nonrandomized study to evaluate endovascular repair of complex aortic aneurysms using fenestrated-branched endografts". Annals of Surgery. 274 (3): 491–499. doi:10.1097/SLA.0000000000004982.
  9. ↑ 9.00 9.01 9.02 9.03 9.04 9.05 9.06 9.07 9.08 9.09 9.10 9.11 9.12 9.13 9.14 9.15 9.16 9.17 9.18 9.19 Isselbacher EM, Preventza O, Hamilton Black J 3rd; et al. (2022). "2022 ACC/AHA guideline for the diagnosis and management of aortic disease: a report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines". Journal of the American College of Cardiology. 80 (24): e223–e393. doi:10.1016/j.jacc.2022.08.004.
  10. ↑ 10.0 10.1 Vilacosta I, San Román JA, di Bartolomeo R; et al. (2021). "Acute aortic syndrome revisited: JACC state-of-the-art review". Journal of the American College of Cardiology. 78 (21): 2106–2125. doi:10.1016/j.jacc.2021.09.022.
  11. ↑ 11.0 11.1 11.2 Czerny M, Grabenwöger M, Berger T; et al. (2024). "EACTS/STS guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ". European Journal of Cardio-Thoracic Surgery. 65 (2): ezad426. doi:10.1093/ejcts/ezad426.
  12. ↑ 12.0 12.1 Daviú-Molinari T, Chin-Bong Choi J, Roberts MC; et al. (2024). "In-hospital mortality risk after endovascular and open aortic aneurysm repairs for ruptured abdominal aortic aneurysms". Journal of Vascular Surgery. 80 (5): 1448–1454.e1. doi:10.1016/j.jvs.2024.07.022.
  13. ↑ 13.0 13.1 Wang LJ, Locham S, Al-Nouri O; et al. (2020). "Endovascular repair of ruptured abdominal aortic aneurysm is superior to open repair: propensity-matched analysis in the Vascular Quality Initiative". Journal of Vascular Surgery. 72 (2): 498–507. doi:10.1016/j.jvs.2019.11.063.
  14. ↑ Erwin JP 3rd, ACC Solution Set Oversight Committee, Cibotti-Sun M, Elma M (2022). "2022 aortic disease guideline-at-a-glance". Journal of the American College of Cardiology. 80 (24): 2348–2352. doi:10.1016/j.jacc.2022.10.001.
  15. ↑ Lederle FA, Kyriakides TC, Stroupe KT; et al. (2019). "Open versus endovascular repair of abdominal aortic aneurysm". The New England Journal of Medicine. 380 (22): 2126–2135. doi:10.1056/NEJMoa1715955.
  16. ↑ Varkevisser RRB, Carvalho Mota MT, Swerdlow NJ; et al. (2022). "Long-term age-stratified survival following endovascular and open abdominal aortic aneurysm repair". Journal of Vascular Surgery. 76 (4): 899–907.e3. doi:10.1016/j.jvs.2022.03.867.
  17. ↑ 17.0 17.1 Chaikof EL, Dalman RL, Eskandari MK; et al. (2018). "The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm". Journal of Vascular Surgery. 67 (1): 2–77.e2. doi:10.1016/j.jvs.2017.10.044.
  18. ↑ 18.0 18.1 Hahl T, Protto S, Järvenpää V; et al. (2022). "Long-term outcomes of endovascular aneurysm repair according to instructions for use adherence status". Journal of Vascular Surgery. 76 (3): 699–706.e2. doi:10.1016/j.jvs.2022.03.010.
  19. ↑ 19.0 19.1 19.2 De Guerre LEVM, O'Donnell TFX, Varkevisser RRB; et al. (2022). "The association between device instructions for use adherence and outcomes after elective endovascular aortic abdominal aneurysm repair". Journal of Vascular Surgery. 76 (3): 690–698.e2. doi:10.1016/j.jvs.2022.02.037.
  20. ↑ 20.0 20.1 20.2 Nana P, Apostolidis G, Panuccio G; et al. (2026). "Long-term outcomes of fenestrated and branched endovascular aortic repair for complex aortic aneurysms in a high-volume aortic center". Annals of Surgery. 284 (2): 404–412. doi:10.1097/SLA.0000000000007070.
  21. ↑ Antonopoulos CN, Pitros CF, Rorris FP, Geroulakos G (2026). "Fenestrated and branched endovascular vs. open repair for complex abdominal aortic aneurysms: a design stratified meta-analysis". European Journal of Vascular and Endovascular Surgery. doi:10.1016/j.ejvs.2026.07.002.
  22. ↑ Yazar O, Willems S, Salemans PB; et al. (2023). "Treatment of aortoiliac aneurysms: compatibility of the E-liac stent graft (Artivion, iliac branch device) with Endurant II or IIs (Medtronic, EVAR)". Cardiovascular and Interventional Radiology. 46 (2): 187–193. doi:10.1007/s00270-022-03352-3.
  23. ↑ 23.0 23.1 Sousa LHD, Baptista-Silva JC, Vasconcelos V, Flumignan RL, Nakano LC (2020). "Internal iliac artery revascularisation versus internal iliac artery occlusion for endovascular treatment of aorto-iliac aneurysms". The Cochrane Database of Systematic Reviews. 7: CD013168. doi:10.1002/14651858.CD013168.pub2.
  24. ↑ 24.0 24.1 D'Oria M, Manoranjithan S, Scoville C; et al. (2024). "Systematic review of risk factors and outcomes of post-implantation syndrome following endovascular aortic repair". Journal of Vascular Surgery. 79 (5): 1240–1250.e4. doi:10.1016/j.jvs.2023.12.029.
  25. ↑ Arnaoutoglou E, Kouvelos G, Papa N; et al. (2016). "Prospective evaluation of postimplantation syndrome evolution on patient outcomes after endovascular aneurysm repair for abdominal aortic aneurysm". Journal of Vascular Surgery. 63 (5): 1248–1255. doi:10.1016/j.jvs.2015.11.043.
  26. ↑ 26.0 26.1 Upchurch GR, Escobar GA, Azizzadeh A; et al. (2021). "Society for Vascular Surgery clinical practice guidelines of thoracic endovascular aortic repair for descending thoracic aortic aneurysms". Journal of Vascular Surgery. 73 (1S): 55S–83S. doi:10.1016/j.jvs.2020.05.076.
  27. ↑ 27.0 27.1 Chaer R, Ochoa Chaar CI, Yuo T, et al. The Society for Vascular Surgery's multidisciplinary management guide on the perioperative care of patients with vascular disease. Society for Vascular Surgery; 2023.
  28. ↑ Smith T, Quencer KB (2020). "Best practice guidelines: imaging surveillance after endovascular aneurysm repair". AJR. American Journal of Roentgenology. 214 (5): 1165–1174. doi:10.2214/AJR.19.22197.
  29. ↑ Al-Thani H, Alrawi O, Elmenyar E; et al. (2025). "Open surgical versus endovascular repair for type B aortic dissection: umbrella review and meta-analysis". Angiology. doi:10.1177/00033197251392660.
  30. ↑ Nakajima K, Kato N, Chino S; et al. (2022). "Therapeutic window for obtaining favorable remodeling after thoracic endovascular aortic repair of type B aortic dissection". Journal of Vascular Surgery. 75 (3): 861–867. doi:10.1016/j.jvs.2021.09.043.
  31. ↑ 31.0 31.1 Miyairi T, Miyata H, Chiba K; et al. (2018). "Influence of timing after thoracic endovascular aortic repair for acute type B aortic dissection". The Annals of Thoracic Surgery. 105 (5): 1392–1396. doi:10.1016/j.athoracsur.2017.11.054.
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