Name of the Procedure:

Endovascular Repair of Descending Thoracic Aorta (Technical terms: TEVAR - Thoracic Endovascular Aortic Repair, involving the left subclavian artery origin coverage)

Summary

Endovascular repair of the descending thoracic aorta is a minimally invasive procedure where an endovascular stent-graft is placed to reinforce the wall of the aorta and prevent it from rupturing. This procedure covers the origin of the left subclavian artery to address issues such as aneurysms, pseudoaneurysms, dissections, penetrating ulcers, intramural hematomas, or traumatic disruptions.

Purpose

This procedure addresses a weakened or damaged section of the descending thoracic aorta. The main goals are to prevent aortic rupture, alleviate symptoms, and improve blood flow through the aorta to maintain proper circulation.

Indications

• Symptoms of aortic aneurysm (e.g., chest/back pain).
• Diagnosed aortic dissection or pseudoaneurysm.
• Penetrating aortic ulcer or intramural hematoma.
• Traumatic aortic injury.
• Enlarged or symptomatic aorta identified through imaging studies.

Preparation

• Fasting typically required at least 6 hours before the procedure.
• Medication adjustments, particularly anticoagulants or antiplatelet agents.
• Pre-procedure imaging tests such as a CT scan or MRI to map the aorta.
• Blood tests to assess overall health status.

Procedure Description

1. The patient is placed under general anesthesia.
2. A small incision is made, usually in the groin area, to access the femoral artery.
3. A catheter is threaded through the artery to the aorta.
4. Using fluoroscopy, a stent-graft is guided to the site of the aortic pathology.
5. The stent-graft is expanded to reinforce the damaged aortic wall and exclude the pathological area from blood flow.
6. Additional grafts may be placed as needed to cover the left subclavian artery origin or extend further.
7. The incision is closed, and the catheter is removed.

Duration

The procedure typically takes between 2 to 4 hours.

Setting

The procedure is performed in a hospital's catheterization lab or operating room equipped for endovascular surgeries.

Personnel

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

Risks and Complications

• Infection at the incision site.
• Bleeding or hematoma.
• Endoleak (leakage around the stent-graft).
• Stroke or paralysis if blood flow to the spinal cord is interrupted.
• Graft migration or thrombosis.
• Aortic rupture or dissection during the procedure.

Benefits

• Minimally invasive compared to open surgery.
• Shorter recovery time and reduced hospital stay.
• Effective in preventing aortic rupture and related complications.
• Immediate improvement in symptoms caused by aortic pathology.

Recovery

• Hospital stay of 1-3 days post-procedure.
• Pain management using prescribed medication.
• Avoid heavy lifting and strenuous activities for several weeks.
• Follow-up appointments and imaging tests to monitor the stent-graft.

Alternatives

• Open surgical repair of the thoracic aorta.
  • Pros: Direct access and comprehensive treatment of the aorta.
  • Cons: Longer recovery time, higher risk of complications.
• Medical management and regular monitoring.
  • Pros: Non-invasive, suitable for small or asymptomatic aneurysms.
  • Cons: Risk of spontaneous aortic rupture or deterioration.

Patient Experience

During the procedure, the patient will be under anesthesia and won't feel anything. After the procedure, the patient may experience discomfort at the incision site and will be managed with pain medication. Close monitoring in the hospital is necessary to ensure there are no immediate complications. Most patients can return to normal activities within a few weeks, with follow-up visits to ensure the stent-graft is functioning properly.