Endovascular Management of Complex Thoracic Aortic Pathologies: Experience with TEVAR in a Single Center in Pakistan

Abstract

Objectives: This study aims to evaluate the technical success and safety of Thoracic Endovascular Aortic Repair (TEVAR) and covered stent placement in the treatment of various thoracic aortic pathologies at a single tertiary care center in Pakistan. Methodology: A retrospective analysis was conducted at Shifa International Hospital, Islamabad, Pakistan, from January 2019 to December 2024. The study included patients diagnosed with thoracic aortic aneurysms, aortic dissection, traumatic aortic transection, pseudoaneurysms, and aortic coarctation. Diagnostic imaging findings, procedural characteristics, device selection, and post-procedure outcomes were systematically reviewed. Results: A total of 12 patients underwent endovascular intervention, comprising 10 TEVAR procedures and 2 covered stent placements for aortic coarctation. The male-to-female ratio was 2:1, with an age range of 25 to 76 years. The most common pathology was traumatic aortic transection (36.36%). The overall technical success rate was 100%. Two cases of type II endoleaks occurred in post-TEVAR patients and were managed conservatively. No perioperative mortality, stroke, or spinal cord ischemia was observed. Conclusion: TEVAR and covered stents represent safe and effective alternatives to open surgery in managing complex thoracic aortic diseases, demonstrating favorable short-term outcomes. However, the limited availability of stent grafts in Pakistan poses a significant challenge. Larger, multicenter studies with extended follow-up are warranted to validate these findings.