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Home > Press Center > Press Releases from 2005 Annual Meeting > Recommended Standards for Thoracic Endovascular Aortic Repair Issued

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Jill Goodwin
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A report that defines the skills, knowledge and experience necessary to perform thoracic endovascular aortic repair (TEVAR) safely and effectively has been published in the April issue of the Journal of Vascular Surgery.

"TEVAR is a new alternative to open surgical repair for a number of diseases of the thoracic aorta, the most common of which is thoracic aneurysmal disease, a life-threatening condition because of the risk of rupture of the aneurysm which often leads to fatal bleeding,” said Dr. Kim Hodgson, MD, chair of the division of vascular surgery at Southern Illinois University School of Medicine, Springfield, Ill., and the Society for Vascular Surgery’s Education Council. “By virtue of being minimally invasive, TEVAR has been associated with reduced mortality and morbidity, shorter periods of hospitalization, and a more rapid recovery for the patient. Instead of repairing the aneurysm directly from the outside which would require opening the chest cavity, the TEVAR procedure inserts a type of liner, termed an endograft, within the aneurysm, replacing the diseased segment from the inside, a technique termed endovascular repair.”

To establish consensus for recommended clinical competencies required for this procedure, Hodgson collaborated with experts in the performance of TEVAR and related minimally invasive procedures including other vascular surgeons, interventional cardiologists, interventional radiologists and interventional vascular medicine specialists.

Not only does TEVAR allow safer repair for those patients who otherwise would have been treated with open surgery, but it also permits repair of thoracic aneurysms in patients who would have been considered unfit for repair by previously available means, offering them treatment for a life-threatening condition that otherwise would have gone untreated. 

A multidisciplinary approach may be advisable to insure that all of the necessary skills and expertise are available to the patient. Despite being based on endovascular techniques common to vascular surgeons and the other specialties who collaborated on these guidelines, vascular surgical expertise is still required since the catheters used to place the endograft are too large to be inserted directly through the skin, requiring direct vascular surgical exposure of an artery in the groin or lower abdomen. Furthermore, up to a quarter of patients may require a limited bypass in the shoulder area to allow their thoracic aortic disease to be treated with TEVAR. 

The report notes that those applying for TEVAR privileges should have the highest level of certification in their specialty and delineates four skills that must be met individually or collectively by the team involved in the procedure:

1. They must have the ability to interpret CT scans of the thoracic aorta and their 3D reconstructions so that they can select suitable TEVAR candidates and make the appropriate measurements to plan and perform the TEVAR procedure. To demonstrate this ability, a TEVAR operator should have successfully performed 25 abdominal endografts or 10 thoracic endografts in the previous two years.
2. At least one member of the team must have comprehensive peripheral endovascular skills necessary to perform the requisite catheter manipulations and be able to address potential complications.* 
3. Knowledge of thoracic aortic pathology; its diagnosis, natural history, and management options; and recognition and treatment of its complications including spinal cord ischemia, stroke, renal failure, myocardial ischemia and atheroemoblization.
4. The ability to obtain and repair access to the vascular system at the brachial, common femoral or iliac artery levels, and perform any necessary brachiocephalic revascularizations. 

“It is essential for individuals on the TEVAR team to maintain certification and privileges in their core disciplines,” added Hodgson. “Furthermore, during every two-year period they should complete at least 10 CME hours pertaining to TEVAR and the TEVAR program should successfully perform at least 10 TEVAR procedures. If TEVAR is done independently by surgeons, multi-specialty consensus criteria for comprehensive endovascular credentialing should be followed to insure that they are qualified and can address potential complications.”

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*Recommended multi-specialty guidelines for these skills have been previously published and include the recently published American College of Cardiology, American College of Physicians, Society for Cardiovascular Angiogrophy and Intervention, Society for Vascular Medicine and Biology, SVS vascular medicine and catheter-based peripheral vascular interventions clinical competence statement, or the American Heart Association training standards for physicians performing peripheral angioplasty and other percutaneous peripheral vascular interventions.