Post‑TEVAR Rupture Risk Factors and Surveillance Strategy

Primary Sources of Rupture

Endoleaks are the single most important risk factor for aortic rupture after TEVAR, occurring in up to 20 % of treated patients (American College of Radiology) 1.
Endoleaks are defined as persistent blood flow into the aneurysm sac and are classified into five types, each requiring evaluation for possible re‑intervention (American College of Radiology) 1.
Early identification of endoleaks through surveillance imaging is essential because they can manifest in the immediate post‑procedural period (American College of Radiology) 1.
Stent‑graft‑induced new entry tears are common complications after TEVAR for chronic type B dissection and represent a direct source of potential rupture (American College of Radiology) 2.
Graft collapse, although rare, can be devastating and lead to acute rupture (American College of Radiology) 1.
Stent‑graft migration occurs in 0.7 %–4 % of cases and can create gaps that allow pressurization of the aneurysm sac (American College of Radiology) 1.
Stent fracture is another mechanical failure that may cause loss of seal and subsequent rupture (American College of Radiology) 1.
Retrograde type A dissection is a catastrophic early complication caused by retrograde extension of the dissection into the ascending aorta after stent placement (American College of Radiology) 2.

Incomplete thrombosis or failure of the false lumen to shrink are negative prognostic indicators of ongoing rupture risk (American College of Radiology) 1.
The number, location, and size of intimal tears correlate with unfavorable aortic remodeling and increased rupture potential (American College of Radiology) 1.
Persistent aneurysmal sac enlargement occurs in 7 %–15 % of cases and suggests disease progression or device failure (American College of Radiology) 1.

Approximately 35 % of patients undergoing TEVAR experience at least one aorta‑specific complication post‑operatively, with roughly half requiring re‑intervention (American College of Radiology) 1.
In patients initially deemed uncomplicated, 37.5 % develop complications within a mean of 7.1 days after presentation, underscoring the need for close early follow‑up (American College of Radiology) 1.
Imaging at 1 month after TEVAR is critical for detecting complications before rupture occurs (American College of Radiology) 1.

Assessment Item	Rationale
Graft stability and position	Detect migration, collapse, or fracture that could compromise seal
True‑lumen and false‑lumen diameters	Evaluate remodeling and residual pressurization
Presence and type of endoleak	Identify ongoing sac perfusion requiring intervention
Stent‑graft migration or fracture	Recognize mechanical failures that predispose to rupture
Signs of retrograde dissection extension	Early detection of retrograde type A dissection

All items should be evaluated on the immediate post‑TEVAR study (American College of Radiology) 1.

CT of the chest, abdomen, and pelvis with intravenous contrast using a multiphase protocol is the standard modality for comprehensive post‑TEVAR assessment, enabling detection of endoleaks, stent‑graft complications, and measurement of aneurysm sac size (American College of Radiology) 1.