Endovascular Thoracic Aneurysm Repair
What is thoracic aneurysm of the descending aorta?
An aneurysm refers to a weakened area in the wall of an artery, which forms an abnormal bulge in the blood vessel. Thoracic aortic aneurysm refers to an aneurysm in the aorta (the largest artery in the body that carries blood away from the heart to the different parts of the body) at the thoracic (chest) region.
The aorta is made of the following parts:
- Ascending aorta: first part that moves away from the heart and towards the head
- Aortic arch: middle part which is curved
- Descending aorta: last part that travels down towards the feet
Descending thoracic aortic aneurysm is characterized by an aneurysm in the part of the aorta that travels down the body through the thoracic or chest region. Thoracic aneurysm can be treated through endovascular thoracic aneurysm repair.
What are the indications for endovascular thoracic aortic aneurysm repair of the descending aorta?
Endovascular thoracic aortic aneurysm repair is indicated based on the size or rate of growth and symptoms of the aortic aneurysm. If the descending thoracic aortic aneurysm is small and asymptomatic, “watchful waiting” is recommended. Your doctor will closely monitor the aneurysm for any changes that may occur. Surgery is recommended for aneurysms
- Reaching a size of ≥6. 0 cm
- Growing at the rate of ≥1 cm per year
- Aortic rupture or dissection (tearing of the aortic wall)
Quitting smoking and taking blood pressure medications are found to slow down the rate of enlargement of an aneurysm. If the thoracic aortic aneurysm is large and symptomatic, prompt treatment is required to prevent a rupture from occurring.
How is endovascular thoracic aneurysm repair of the descending aorta performed?
The thoracic endovascular aneurysm repair (TEVAR) is a less-invasive procedure to treat descending thoracic aortic aneurysms. You will be examined for compatibility with the delivery systems and stent grafts. Your doctor makes a small incision in the groin. A stent graft (a mesh tube covered with a synthetic graft material) is then inserted through a catheter (a thin long tube) into the femoral artery (large artery in the groin). The stent holds the graft in place. Your surgeon uses live X-rays to guide the stent graft up into the aorta to the region of the aneurysm. Once placed in the correct location, the stent graft is expanded (spring like mechanism) to hold tightly against the wall of the aorta. Blood now flows through the stent graft, bypassing the aneurysm. The aneurysm will gradually shrink around the stent graft.
What can you expect after endovascular thoracic aneurysm repair of the descending aorta?
Following surgery, you will be required to stay in the hospital for one or two days. You will be able to return to your normal activities in about a week.
Are there any complications of endovascular thoracic aneurysm repair of the descending aorta?
As all surgical procedures, endovascular thoracic aneurysm repair of the descending aorta may be associated with certain complications that may include, but are not limited to:
- Blood leakage around the graft
- Stent fracturing
- Migration of the graft from its initial position
- Rupture of the aneurysm
What are the advantages of endovascular over open thoracic aneurysm repair of the descending aorta?
The advantages of endovascular thoracic aneurysm repair over open surgery include:
- Smaller incisions
- Less blood loss
- Smaller chances of renal, visceral, or spinal cord ischemia (restricted blood supply to tissues)
- Faster recovery
- Shorter hospital stay
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