Comparison of open surgery and endovascular repair for aortic disease.

Open vs. Endovascular Repair: Which Is Best for Thoracic Aortic Disease?

Elliot Brynn in Health & Wellness October 2026 • 4 min read.

"A comparative analysis of open surgical repair (OSR) and thoracic endovascular repair (TEVAR) for treating isolated descending thoracic aortic disease, weighing benefits, risks, and long-term outcomes."

The landscape of thoracic aortic disease treatment is evolving, primarily due to the rising incidence of degenerative aortic conditions. Historically, conventional open surgery has been the standard approach. However, the emergence of thoracic endovascular repair (TEVAR) offers a less invasive alternative, prompting a re-evaluation of treatment strategies.

Open surgical repair (OSR), involves a thoracotomy to access and repair the affected aorta. While OSR has a long track record of success, it's associated with significant mortality and morbidity, including neurologic complications. This has fueled the search for less invasive techniques.

TEVAR involves the placement of a stent graft within the aorta to reinforce the weakened vessel. TEVAR has expanded rapidly, offering a potentially safer approach for high-risk patients. However, challenges remain, including endoleaks, graft migration, and uncertainty regarding long-term durability.

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Stats & Impact

Thoracic Anatomy

The thoracic cavity is a space in the chest that contains the heart, lungs, and other organs and tissues. Its main parts are the pleural cavities and the mediastinum. The thoracic spine is the middle section of the spine, consists of 12 vertebrae, and is especially rigid and stable.

TEVAR vs. OSR: A Head-to-Head Comparison of Outcomes

Comparison of open surgery and endovascular repair for aortic disease.

A recent study published in the Korean Journal of Radiology compared the midterm outcomes of OSR and TEVAR for isolated descending thoracic aortic disease. The study retrospectively reviewed 68 patients treated between 2006 and 2010, dividing them into two groups: OSR (n=40) and TEVAR (n=28). The researchers analyzed perioperative complications, 30-day mortality, clinical success, and long-term survival.

The study revealed several key findings. Patients undergoing TEVAR were significantly older (mean age 63 years) than those undergoing OSR (mean age 54 years). Significant perioperative complications occurred in 20% of the OSR group and 13% of the TEVAR group. The 30-day mortality rate was 10% in the OSR group and 3.6% in the TEVAR group. Clinical success, defined as effective aortic remodeling and complete false lumen obliteration or thrombosis, was achieved in 71% of TEVAR patients.

Age: TEVAR patients were older on average.
Complications: OSR had a slightly higher rate of perioperative complications.
Mortality: OSR showed a higher 30-day mortality rate.
Clinical Success: TEVAR demonstrated a 71% success rate in aortic remodeling.
Survival: One-year survival rates were comparable between both groups.

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Latest Research

Long-Term Evidence

A long-term study reported that mortality odds after endovascular repair of the descending thoracic aorta were significantly higher at 5 years (OR, 1.330; 95% CI, 1.182-1.496) and 10 years (OR, 1.257; 95% CI, 1.128-1.401). Research on endovascular repair for thoracic aortic disease therefore continues to debate its long-term efficacy. In one reported 5-year experience, the true lumen increased in 54% of patients, while the false lumen decreased by more than 5 mm in 39%.

Counterpoints

Study Limitations

Evidence comparing open surgical repair with thoracic endovascular repair for isolated descending thoracic aortic disease has important limitations. The reported study had a relatively short follow-up duration and a small study population. The same limitations were identified in the corresponding report published by the Korean Journal of Radiology.

While the one-year Kaplan-Meier survival rate was similar for both groups (87% for OSR and 80% for TEVAR), the study highlighted the ongoing challenges associated with TEVAR, such as the potential for endoleaks and rupture. These complications necessitate close follow-up to evaluate long-term outcomes.

The Future of Aortic Disease Treatment

Thoracic endovascular repair presents a viable alternative to open surgical repair for isolated thoracic aortic disease, offering comparable midterm results. However, the potential for late adverse events, such as endoleakage or rupture, requires continued close monitoring and long-term follow-up to ensure satisfactory outcomes.

TEVAR's early results compared with open repair

nearly 100% procedural successThe paper described TEVAR’s procedural success as nearly 100%, while characterizing its early results as significantly superior to open repair; it did not provide a precise success percentage in this statement.^[1]

What limits confidence in this comparison

Treatment allocation reflected clinical circumstances: acute or complicated cases generally received open surgery, while some high-risk traumatic cases were directed to endovascular repair.^[2]
The endovascular group also included hybrid procedures involving left subclavian artery debranching, so it was not limited to TEVAR alone.^[2]

A retrospective comparison of repair approaches for descending thoracic aortic disease

Population	Patients with isolated descending thoracic aortic disease^[2]
Sample size	68 patients^[2]
Duration	Median follow-up of 17.2 months^[2]
Main outcome	Perioperative complication, 30-day mortality, and clinical success^[2]
p-value	p = 0.65 for 1-year survival^[2]
Times cited	12^[2]

What a longer and more comparable follow-up could clarify

Would the early procedural advantage described by the authors remain when outcomes are followed over a longer period?^{[1] [2]}
How often do later graft-related events alter outcomes after endovascular repair, given the paper’s call for continued imaging follow-up?^{[1] [2]}

Sources

Midterm Outcomes of Open Surgical Repair Compared with Thoracic Endovascular Repair for Isolated Descending Thoracic Aortic Disease (Europe PMC, 2012)
Midterm Outcomes of Open Surgical Repair Compared with Thoracic Endovascular Repair for Isolated Descending Thoracic Aortic Disease (The Korean Society of Radiology, 2012)

About this Article -

Written with AI assistance from published research, and reviewed by the Mystum team. See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.3348/kjr.2012.13.4.476, Alternate LINK

Title: Midterm Outcomes Of Open Surgical Repair Compared With Thoracic Endovascular Repair For Isolated Descending Thoracic Aortic Disease

Subject: Radiology, Nuclear Medicine and imaging

Journal: Korean Journal of Radiology

Publisher: The Korean Society of Radiology

Authors: Seung Hyun Lee, Cheol Hyun Chung, Sung Ho Jung, Jae Won Lee, Ji Hoon Shin, Ki Young Ko, Hyun Ki Yoon, Suk Jung Choo

Published: 2012-01-01

Everything You Need To Know

What is open surgical repair (OSR) and how does it relate to the treatment of thoracic aortic disease?

Open surgical repair (OSR) involves a thoracotomy to access and repair the affected aorta. It has been the standard approach for treating thoracic aortic disease historically. While OSR has a proven track record, it is associated with significant risks, including high mortality and morbidity, such as neurologic complications. These challenges have driven the search for less invasive techniques like TEVAR.

What is thoracic endovascular repair (TEVAR) and what are its benefits in treating aortic disease?

Thoracic endovascular repair (TEVAR) involves inserting a stent graft within the aorta to reinforce the weakened vessel. TEVAR is a less invasive procedure compared to open surgical repair (OSR), making it a potentially safer option, particularly for patients at higher risk. While TEVAR offers advantages like potentially reduced mortality, it still comes with its challenges such as the risk of endoleaks, graft migration, and the need for long-term monitoring to assess durability.

What were the main findings of the study comparing TEVAR and OSR for thoracic aortic disease?

The study compared open surgical repair (OSR) and thoracic endovascular repair (TEVAR) for isolated descending thoracic aortic disease. The study examined key metrics such as perioperative complications, 30-day mortality, clinical success, and long-term survival. The findings revealed that patients undergoing TEVAR were, on average, older than those undergoing OSR. The study also noted that OSR had a higher 30-day mortality rate than TEVAR. Clinical success, defined as effective aortic remodeling and complete false lumen obliteration or thrombosis, was achieved in 71% of TEVAR patients.

Were there any key differences in outcomes between open surgical repair (OSR) and thoracic endovascular repair (TEVAR)?

One significant difference is the 30-day mortality rate. The study found that the 30-day mortality rate was higher in the Open surgical repair (OSR) group (10%) compared to the Thoracic endovascular repair (TEVAR) group (3.6%). This indicates that TEVAR may offer a survival benefit in the short term, potentially making it a preferred option for high-risk patients.

Why is long-term follow-up important after thoracic endovascular repair (TEVAR)?

While the one-year survival rates were comparable for both open surgical repair (OSR) and thoracic endovascular repair (TEVAR), the potential for late adverse events with TEVAR, like endoleaks and rupture, necessitates continued close monitoring. This highlights the need for careful long-term follow-up to ensure satisfactory outcomes and to address any complications that may arise. Ongoing monitoring is critical to assess the durability and effectiveness of the procedure over time.