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The Promise of MR for TEVAR and EVAR
Obtaining both force and anatomic imaging and how this might affect endovascular repair.
By Felix J.V. Schl�sser, MD; Hamid R. Mojibian, MD; Hence j.m. Verhagen, MD, PhD; Frans L. Moll, MD, PhD; david gortler, pharmd; and Bart E. Muhs, MD, PhD
Endovascular aortic aneurysm repair (EVAR) has emerged as a potential treatment modality for many patients in the field of vascular surgery. Since the first endovascular procedures were described by Parodi et al1 in 1991 for abdominal aortic aneurysms (AAAs) and by Dake et al2 in 1994 for thoracic aortic aneurysms (TEVAR), the number of new endovascular techniques and endovascular devices has been growing exponentially. The endovascular frontier is still developing: more experience is gained with the use of fenestrated and branched endografts, and several new devices have been introduced with new dimensions and characteristics. Endovascular repair is likely to expand its potential even further in the future.
However, the first-choice treatment will be determined by balancing the risks and benefits of the treatment for each individual patient. Endovascular repair is, unfortunately, associated with a relatively high incidence of device-related complications after the procedure, such as endoleaks, graft migration, graft kinking, graft thrombosis, and aortic aneurysm rupture. Many of the patients with these complications need a reintervention, which carries additional risk.3-6
Detailed insight into the mechanisms that play a role in the development of these complications is not a simple task, and we cannot predict which patients will develop complications. All patients are requested to undergo several follow-up examinations after the endovascular procedure to detect complications early.
Further improvements in endograft design and more precise understanding of the mechanisms that are involved in the development of complications will possibly expand the applicability of EVAR and TEVAR to patients with a wider range of characteristics. More developments and insight in the pathological mechanisms of complications are not only likely to expand the applicability of EVAR and TEVAR but are also likely to reduce the risk of complications in patients and improve their prognoses.
Since the application of angiography, several new imaging techniques have been introduced, such as CT and MR imaging. MR imaging has undergone important improvements during recent years with regard to both image quality and the range of applications for clinical use and research. This article discusses the potential of MR imaging and how it may change EVAR and TEVAR in the future.

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