Vascular Access Challenges in Thoracic Endovascular Aortic Repair: A Literature Review

Tim J Mandigers*, Chiara Lomazzi, Maurizio Domanin, Stefano Pirrelli, Gabriele Piffaretti, Joost A van Herwaarden, Santi Trimarchi

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review


BACKGROUND: This review aims to comprehensively summarize access challenges in thoracic endovascular aortic repair (TEVAR) by describing vascular access routes, associated risks, outcomes, and complications.

METHODS: A literature search was conducted utilizing the PubMed (Medline), Scopus, and Web of Science databases. Qualitative and quantitative data from selected studies are extracted and discussed according to available standards for narrative reviews.

RESULTS: In total, there were 109 eligible studies based on predefined inclusion- and exclusion criteria. There were 39 original articles or reviews and 57 case series or case reports. This article summarizes the evidence from these studies and discusses traditional retrograde access routes and techniques for TEVAR via a femoral or iliac route, with or without the use of conduits. Next, alternative antegrade access routes and techniques via a brachial, axillary, carotid, ascending aorta, transapical, transcaval, or another route are discussed. Vascular access complications are presented with specific attention to the importance of gender and alternative antegrade access routes.

CONCLUSIONS: Multiple access routes and techniques are currently available to overcome access challenges associated with TEVAR, based on low grade evidence from heterogeneous studies. Future research that compares different access routes and techniques might help in the development of a tailored access protocol for specific patients with challenging TEVAR access.

Original languageEnglish
Pages (from-to)22-31
Number of pages10
JournalAnnals of Vascular Surgery
Publication statusPublished - Aug 2023


  • Aorta, Thoracic/diagnostic imaging
  • Aorta/surgery
  • Aortic Aneurysm, Thoracic/diagnostic imaging
  • Blood Vessel Prosthesis Implantation/adverse effects
  • Endovascular Aneurysm Repair
  • Endovascular Procedures/adverse effects
  • Humans
  • Retrospective Studies
  • Treatment Outcome


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