Name of the Procedure:

Placement of proximal extension prosthesis for endovascular repair of descending thoracic aorta (Common names: Proximal extension stenting, Endovascular thoracic repair extension)

Summary

In this procedure, a stent graft is placed in the descending thoracic aorta to reinforce the artery's walls and improve blood flow. It is typically used to manage aneurysms, dissections, or other structural issues within the aorta. Specifically, this involves placing an additional proximal extension prosthesis to an already existing endovascular graft.

Purpose

This procedure addresses conditions such as aneurysms, pseudoaneurysms, dissections, penetrating ulcers, intramural hematomas, or traumatic disruptions in the descending thoracic aorta. The goal is to provide structural support to the aorta, prevent rupture, and ensure proper blood flow.

Indications

• Presence of a thoracic aortic aneurysm
• Dissection of the descending thoracic aorta
• Pseudoaneurysm or penetrating aortic ulcer
• Intramural hematoma
• Traumatic disruption of the aorta
• Patients already having an endovascular graft requiring extension

Preparation

• Patient should fast for at least 6-8 hours before the procedure.
• Pre-procedure diagnostic tests, such as a CT scan or MRI, to assess the aorta's condition.
• Adjustment or temporary discontinuation of certain medications, particularly anticoagulants.
• Baseline blood tests and cardiovascular evaluations.

Procedure Description

1. Preoperative Phase:

   • Administer anesthesia (general or local).
   • Place necessary intravenous lines and monitoring equipment.

2. Operative Phase:

   • Insert a catheter through a small incision, typically in the groin or arm.
   • Guide the catheter to the descending thoracic aorta using fluoroscopic imaging.
   • Deploy the proximal extension prosthesis from the catheter to the target site.
   • Expand and secure the stent graft to reinforce the aorta's walls.
   • Confirm the correct placement via imaging.

3. Postoperative Phase:

   • Close the incision and apply a sterile bandage.
   • Monitor the patient in the recovery room.

Duration

The procedure typically takes around 2-4 hours to complete.

Setting

Usually performed in a hospital operating room or a specialized endovascular suite.

Personnel

• Vascular surgeon or interventional radiologist
• Anesthesiologist
• Surgical nurses
• Radiologic technologist

Risks and Complications

• Bleeding or hematoma at the incision site
• Infection
• Endoleak (leakage of blood outside the stent graft)
• Thrombosis or embolization
• Damage to blood vessels or organs
• Nerve injury
• Reaction to contrast dye used in imaging

Benefits

• Prevents aortic rupture and life-threatening bleeding
• Restores proper blood flow in the aorta
• Minimally invasive with quicker recovery times compared to open surgery
• Immediate stabilization of the aortic wall

Recovery

• Close monitoring for the first 24-48 hours for signs of complications.
• Gradual resumption of normal activities over a few days.
• Avoid heavy lifting and strenuous activities for a few weeks.
• Follow-up imaging studies to ensure the prosthesis is functioning correctly.

Alternatives

• Open surgical repair: Involves a larger incision and longer recovery time but may be necessary if endovascular repair is not suitable.
• Medical management: Strict blood pressure control and regular monitoring, though not always a long-term solution.

Patient Experience

• During the procedure: The patient will be under anesthesia and should not feel pain.
• After the procedure: Some soreness or discomfort at the incision site.
• Pain management: Pain relief medications as prescribed.
• Most patients can expect to feel normal within a few weeks.