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Thoracic endovascular aortic repair (TEVAR) has revolutionised BTAI treatment, surpassing the previously standard open surgical repair in mortality and complication rates. Despite its success, concerns arise regarding TEVAR's long\u2010term effects, especially in younger BTAI patients. Key physiological changes following TEVAR include alterations in aortic size, shape, compliance and flow dynamics, leading to loss of the Windkessel effect and a consequent increased pulse wave velocity and decreased radial strain, which can contribute to the development of hypertension. These alterations also predispose patients to changes in cardiovascular flow (increased reverse systolic flow, reduced maximum velocity and altered helical flow), potentially increasing the risk of left ventricular dysfunction and coronary artery disease. Physiological changes also increase the likelihood of complications such as graft migration. Clinical outcomes of TEVAR for BTAI have generally been favourable, with significant reductions in mortality and cerebrovascular accident rates compared to open surgical repair. However, long\u2010term complications, including the need for re\u2010interventions, remain a concern, though studies suggest these are infrequent. The durability of TEVAR in younger patients, who may experience decades of device use, poses unique challenges, particularly due to the natural progression of aortic morphology over time. Therefore, adapting TEVAR to the physiological needs of younger BTAI patients is essential. Developing more compliant endografts and using shorter stents with improved materials can help minimise structural and haemodynamic changes and enhance cardiovascular outcomes, supporting the long\u2010term health of this vulnerable population.<\/jats:p>","DOI":"10.1113\/ep092615","type":"journal-article","created":{"date-parts":[[2025,6,10]],"date-time":"2025-06-10T01:12:41Z","timestamp":1749517961000},"page":"43-53","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Aortic and cardiovascular remodelling after thoracic endovascular aortic repair for blunt traumatic aortic injury in younger patients: A narrative review of physiological and clinical outcomes"],"prefix":"10.1113","volume":"111","author":[{"given":"Marco David","family":"Bokobza De la Rosa","sequence":"first","affiliation":[{"name":"Lancaster Medical School University of Lancaster  Lancaster UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matti","family":"Jubouri","sequence":"additional","affiliation":[{"name":"Hull York Medical School University of York  York UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1440-2719","authenticated-orcid":false,"given":"Thurkga","family":"Moothathamby","sequence":"additional","affiliation":[{"name":"Barts and the London School of Medicine and Dentistry Queen Mary University of London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Refaie","sequence":"additional","affiliation":[{"name":"Department of General Surgery  Ysbyty Glan Clwyd, Rhyl Wales"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Murtada","sequence":"additional","affiliation":[{"name":"Department of General Surgery  Ysbyty Glan Clwyd, Rhyl Wales"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5981-9705","authenticated-orcid":false,"given":"Idhrees","family":"Mohammed","sequence":"additional","affiliation":[{"name":"Institute of Cardiac and Aortic Disorders (ICAD) SRM Institutes for Medical Science (SIMS Hospital)  Chennai India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian M.","family":"Williams","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery University Hospital of Wales  Cardiff UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0498-7095","authenticated-orcid":false,"given":"Damian M.","family":"Bailey","sequence":"additional","affiliation":[{"name":"Neurovascular Research Laboratory, Faculty of Life Sciences and Education University of South Wales  Pontypridd UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8040-5811","authenticated-orcid":false,"given":"Mohamad","family":"Bashir","sequence":"additional","affiliation":[{"name":"Neurovascular Research Laboratory, Faculty of Life Sciences and Education University of South Wales  Pontypridd UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,6,9]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/tsaco-2021-000678"},{"key":"e_1_2_8_3_1","volume-title":"Blunt Thoracic Aortic Injury: Current Issues and Endovascular Treatment Paradigms","author":"Adams J. 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