Name of the Procedure:

Placement of Distal Extension Prosthesis(s) Delayed After Endovascular Repair of Descending Thoracic Aorta

Summary

This procedure involves placing an additional prosthetic device in the descending thoracic aorta after previously undergoing endovascular repair. It is performed to extend the initial repair and ensure proper blood flow through the aorta.

Purpose

The procedure addresses complications or issues that may arise post-endovascular repair, such as incomplete aortic coverage or aneurysm growth. The goal is to secure the repair, prevent aneurysm rupture, and improve overall cardiovascular health.

Indications

• Persistent or new aneurysms in the descending thoracic aorta.
• Endoleak (blood leakage into the aneurysm sac post-repair).
• Expansion or further degeneration of the aortic segment.
• Patients who have previously undergone endovascular aortic repair showing signs of incomplete treatment.

Preparation

• Patients may need to fast for 6-8 hours before the procedure.
• Medications, especially blood thinners, might need adjustments as directed by the healthcare provider.
• Pre-procedure imaging tests (e.g., CT scans, MRIs) to assess the aorta and plan the procedure.

Procedure Description

1. The patient is given anesthesia to ensure they are comfortable and pain-free during the procedure.
2. A small incision is made, usually in the groin area, to access blood vessels.
3. A catheter is guided through the blood vessels to the descending thoracic aorta using fluoroscopic imaging.
4. The distal extension prosthesis is carefully placed and expanded within the aorta to reinforce the previous repair.
5. The catheter is withdrawn, and the incision is closed.

Duration

The procedure typically takes 2-4 hours, but this can vary depending on individual patient factors.

Setting

The procedure is usually carried out in a hospital’s vascular surgery or interventional radiology suite.

Personnel

• Vascular surgeon or interventional radiologist
• Surgical nurses
• Anesthesiologist

Risks and Complications

• Infection at the incision site
• Blood vessel damage
• Endoleak or graft migration
• Kidney damage from contrast dye
• Stroke or other cardiovascular events

Benefits

• Improved stability and function of the aorta
• Prevention of aneurysm rupture
• Potential relief from symptoms associated with aortic aneurysms
• Enhanced long-term outcomes after initial aortic repair

Recovery

• Post-procedure monitoring in a recovery room for a few hours.
• Hospital stay of 1-2 days typically.
• Instructions on wound care and activity restrictions.
• Follow-up appointments for imaging tests to ensure the prosthesis is functioning correctly.
• Gradual return to normal activities as advised by the healthcare provider.

Alternatives

• Open surgical repair of the aorta.
• Continued monitoring and medical management if the risk of intervention outweighs the benefits.
• Hybrid procedures combining open surgery and endovascular techniques.
• Each alternative comes with its own set of risks and benefits to be weighed by the patient and healthcare provider.

Patient Experience

• The patient will be under anesthesia and should not feel pain during the procedure.
• Mild discomfort at the incision site may be experienced post-procedure.
• Pain management includes prescribed medications to alleviate any pain.
• Patients can expect some restrictions on activities and should report any unusual symptoms to their healthcare provider promptly.