Abstract
Since the first thoracic endograft was placed in 1994 for descending thoracic aneurysm disease,1 multicentre trials2e4 and comparative analyses5 have confirmed reduced early morbidity and mortality over its open counterpart.6 As such, thoracic endovascular repair [TEVAR] is now an accepted treatment for descending thoracic aortic aneurysm (DTA) in the elderly and high risk populations.7,8 These techniques have been successfully adapted for the treatment of other thoracic aortic conditions such as dissection9,10 and blunt injury,11,12 bringing a younger cohort of patients and with it, concerns regarding its long term durability and efficacy. If we can extrapolate from the infrarenal EVAR experience, early reductions in morbidity and mortality may be coupled with an increased need for reinterventions and an uncertainty in long term prevention of aortic related death.13 Similarly, there is no evidence that TEVAR in descending thoracic aneurysmal disease is superior to its open counterpart for long term outcomes.6 This paucity of convincing long term data and the high need for reintervention has led to recommendations for lifelong surveillance.7,8
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