Medical Terminology in this article:
Thoracic Aorta: The part of the aorta that extends through the chest area.
Aneurysm: A weakening in the wall of a blood vessel which results in an abnormally dilated area.
Endovascular: Referred to within a vessel.
Sheath: Thin, flexible tubes
Fluoroscopy: Real time X-ray
Guidewires: Thin, flexible wire
Stent: A metal mesh tube with a layer of fabric
What is Thoracic Aortic Aneurysm?
A thoracic aortic aneurysm is a weak area in the aorta, the major blood vessel transporting blood from the heart to the rest of the organs. When blood circulates with high pressure, it presses against the artery wall, causing the vessel to expand like a balloon forming an aneurysm.
Aneurysms must be monitored closely because they are prone to rupture at any time leading to death.
What is thoracic endovascular aortic repair (TEVAR)?
The TEVAR procedure involves placing a covered stent into the weakened area of the aggression. This provides a route for the blood to flow without pooling in the bulge causing more weakness in the wall.
Why perform it?
Aneurysm should be monitored by your doctor. It is recommended that you undergo treatment for the aneurysm if it has a certain measurement or expanded within six months to prevent the aneurysm from rupturing, causing death. If the aneurysm is causing symptoms such as pain or abnormal bleeding, you may require treatment.
If the thoracic aneurysm was caused by trauma, such as if the patient was in an accident, TEVAR is a way to rapidly cover the injured area, controlling bleeding and preventing death.
Although surgical treatments for thoracic aortic aneurysms are available, surgery has a significantly higher risk of severe complications and death.
How does it work?
Usually under general anesthesia, the interventional radiologist will make a small cut in the skin over the artery at the top of your legs and insert a sheath (a short tube to maintain safe access to the vessels). Then, guidewires and catheters are inserted to direct them to the affected area under fluoroscopy. A contrast medium (dye) will be injected into the thoracic aorta so that the site clearly shows up under imaging for maximum accuracy. To place the stent, the interventional radiologist will insert it over the guidewire and move it to the correct location. After that, it will expand to seal the aneurysm or cover any leaks in the wall of the vessel.
Following the procedure, your vital signs will be monitored, and you will stay in hospital for 2-3 days. You may experience bruising and pain, though this can be treated with standard painkillers. Walking and moving around once you can is encouraged. You will need to have the stent regularly checked using CT or ultrasound to ensure that the stent is in good condition and avoid long-term problems.
What are the risks?
The rate of successfully placing the stent and covering the aneurysm or tear is usual very high in experienced hands. There are lower rates of pain and serious complications than with surgery. Still, the main risks associated with TEVAR are stent displacement and blood collecting in the aneurysm again. This means that you will require regular monitoring so that if any problems do occur, they can be resolved as soon as possible.
Minor complications include the risk of bruising or groin pain. Some uncommon major complications can include infection, stroke, limb compromise, kidney injury and in rare cases paralysis. The risk of death during the procedure is nearly three times lower than the risk of dying during open surgery.