Thoracic and abdominal endovascular repair (T/EVAR) for the structural support of aortic aneurysm

Published on 30 Aug 2023
Last Updated on 30 Aug 2023

Guidance Recommendations

The Ministry of Health’s Medical Technology Advisory Committee has recommended thoracic and abdominal endovascular repair (T/EVAR) to provide structural support of aortic aneurysm, in line with the following criteria:   

• Patients with abdominal aortic aneurysm (AAA; ruptured or unruptured), who are not suitable for open surgical repair (OSR) and are: 

  • symptomatic; OR

  • asymptomatic and with an aneurysm of 5 cm or larger (measured outer-to-outer maximum anterior-posterior aortic diameter); OR

  • asymptomatic and with an aneurysm that has grown by more than 1cm in one year (measured outer-to-outer maximum anterior-posterior aortic diameter); OR

  • presenting with a small aneurysm (less than 5 cm), but who will also require chemotherapy, radiation therapy, or solid organ transplantation (a shared multidisciplinary decision-making approach should be considered to decide on treatment options).

• Patients with thoracic aortic aneurysm (TAA; ruptured or unruptured) who are not suitable for OSR and are:

  • symptomatic; OR

  • asymptomatic and with an aneurysm of 5.5 cm or larger (measured outer-to-outer maximum anterior-posterior aortic diameter); OR

  • asymptomatic and with an aneurysm that has grown by more than 1 cm in one year (measured outer-to-outer maximum anterior-posterior aortic diameter).

• Patients with thoraco-abdominal aortic aneurysm (TAAA) who are not suitable for OSR and are:

  • symptomatic; OR

  • asymptomatic and with an aneurysm of 5.5 cm or larger (measured outer-to-outer maximum anterior-posterior aortic diameter); OR

  • asymptomatic and with an aneurysm that has grown by more than 1 cm in one year (measured outer-to-outer maximum anterior-posterior aortic diameter).

• Patients with type B aortic dissection (TBAD) with suitable anatomy  for TEVAR and the TBAD is: 

  • Complicated (presence of malperfusion syndrome or rupture) hyperacute (<24 hours), acute (1–14 days), or subacute (15–90 days); OR

  • Uncomplicated with high-risk features (refractory pain, refractory hypertension, bloody pleural effusion, aortic diameter of more than 40 mm, imaging evidence of malperfusion, entry tear on lesser curvature, or false lumen of more than 22 mm).

• Patients with traumatic aortic injury who do not have contraindications to endovascular repair.

Funding status

Aortic stent graft for T/EVAR is recommended for inclusion on the MOH Medical Technology Subsidy List (MTSL). Listed model packages are recommended for subsidy when used in line with the abovementioned recommendations.

Thoracic and abdominal endovascular repair for the structural support of aortic aneurysm [PDF, 166 KB]