Name of the Procedure:

Endovascular Repair of Descending Thoracic Aorta (e.g., aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption); Involving Coverage of Left Subclavian Artery Origin, Initial Endoprosthesis Plus Descending Thoracic Aorta.

Summary

Endovascular repair of the descending thoracic aorta is a minimally invasive procedure used to fix problems in the aorta with a stent graft. This procedure specifically involves covering the origin of the left subclavian artery.

Purpose

This procedure addresses issues such as aneurysms, pseudoaneurysms, dissections, penetrating ulcers, intramural hematomas, or traumatic disruptions in the descending thoracic aorta. The goal is to reinforce the weakened portion of the aorta, preventing rupture and restoring normal blood flow.

Indications

• Large or symptomatic aortic aneurysms
• Aortic dissections
• Pseudoaneurysms
• Penetrating ulcers in the aorta
• Intramural hematomas
• Traumatic aortic disruptions

Preparation

• Fasting for 6-8 hours before the procedure.
• Adjustments to medications, especially blood thinners.
• Preoperative imaging studies like CT scans or MRIs.
• Blood tests and possibly a cardiac evaluation.

Procedure Description

1. The patient is placed under general anesthesia.
2. A small incision is made in the groin area to access a blood vessel.
3. A catheter is inserted through the blood vessel to the site of the aortic problem.
4. A stent graft is delivered through the catheter and positioned in the aorta to cover the affected area, including the origin of the left subclavian artery.
5. Imaging techniques, such as fluoroscopy, are used to ensure proper placement.
6. Once positioned, the stent graft is expanded to fit the aortic wall, securing it in place.
7. The catheter is removed, and the incisions are closed.

Duration

The procedure typically takes 2 to 4 hours.

Setting

This procedure is performed in a hospital operating room or an interventional radiology suite.

Personnel

• Vascular surgeons or interventional radiologists
• Nurses
• Anesthesiologists
• Radiologic technologists

Risks and Complications

• Bleeding
• Infection
• Endoleaks (leakage around the stent graft)
• Stroke
• Paralysis
• Kidney damage
• Reactions to contrast dye used in imaging

Benefits

The main benefits include reduced risk of aortic rupture, improved blood flow, and a shorter recovery time compared to traditional open surgery. Many patients experience symptom relief shortly after the procedure.

Recovery

• Patients usually spend 1-2 days in the hospital.
• Instructions may include avoiding heavy lifting and strenuous activities for a few weeks.
• Regular follow-up visits and imaging studies are necessary to monitor the graft.
• Pain management with prescribed medications.

Alternatives

• Open surgical repair: A more invasive procedure with a longer recovery time but may be necessary for some patients.
• Medical management: For patients not fit for surgery, medications to control blood pressure and reduce the risk of aortic damage.
• Regular monitoring: For small, asymptomatic aneurysms, regular imaging to monitor growth.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel any pain. Post-procedure, there may be some discomfort or pain at the incision site, managed with pain medications. Patients may feel fatigue and require some rest and limited activity during the initial recovery phase.