Cardiothoracic Surgery

Endovascular Aortic Repair, TEVAR, EVAR

Your aorta is a tube-like structure that resembles a candy cane. The thoracoabdominal aorta starts after the curve of the cane and extends past the arteries that deliver blood to the stomach, intestines and kidneys.

An aneurysm refers to ballooning out of the aorta which causes aortic wall weakening. The aortic wall may continue to further expand or remain unchanged, but close surveillance is necessary.  As the aortic wall weakens, there is a risk of the wall tearing or dissecting.

What Contributes to the Formation of an Aneurysm?

  • Age and/or degenerative disease of the aortic wall
  • Uncontrolled high blood pressure
  • Long-term use of tobacco
  • Inflammation or swelling of the aorta
  • Infection
  • Past medical history of connective tissue disorders, such as Marfan syndrome, Ehlers-Danlos syndrome or Loeys-Dietz syndrome
  • Trauma

Diagnosis and Symptoms

Individuals usually do not have symptoms.

Individuals with descending thoracic or abdominal aortic aneurysms usually do not have symptoms. Aneurysms are commonly found incidentally. It is possible that as the aneurysm enlarges and compresses surrounding nerves or organs, an individual may experience back or abdominal pain.

Patients that experience sudden symptoms such as chest or back pain, characterized as a tearing sensation, nausea, vomiting, a fast heart beat and possibly the feeling of impending doom, may be experiencing a tear or dissection of the aorta. Left untreated this can lead to rupture and is considered an emergent condition that requires immediate intervention.

Computed tomography or CT scan with or without contrast is the most common imaging study used to evaluate your condition. A CT scan provides valuable information about your aorta, such as the location and size of an aneurysm or dissection. Magnetic resonance imaging (MRI) or magnetic resonance angiography (MRA) is another imaging modality to visualize your aortic aneurysm and vessels.  Similar to a CT scan with contrast, an MRI or MRA provides detailed information about your aorta. Your surgeon will choose the best method for imaging your aorta.

Endovascular Repair of the Aorta

During this operation, the surgeon will make an incision in both sides of your groin to expose the femoral arteries.

A catheter holding a endovascular stent graft will then be inserted in your femoral artery through the opening in your groin. The graft is wrapped tightly around the catheter that places it inside your artery. The surgeon may use an ultrasound device and fluoroscopy (real-time x-ray images) to align the stent within the aorta. Once the stent is in a proper position, it will then be expanded or deployed inside of the aorta. This effectively seals off the aneurysmal section of the aorta and redirects blood flow through the stent graft.

A unique risk of repairing descending thoracic aortic aneurysms is paralysis of the legs. To help prevent this from happening, a very tiny drain will be inserted into your spine by the anesthesiologist after you are asleep. This drain is usually removed within 48 hours after surgery. You will remain in the ICU until the drain is removed. This same risk is not present when repairing the abdominal aorta.

Recovery

It will take you approximately one month to fully recover from undergoing endovascular aortic aneurysm surgery. You should plan to be away from work, getting your full strength back, for approximately four weeks. Your surgeon will advise you on post-operative restrictions and when it's safe to drive again.