Name of the Procedure:

Endovascular Repair of Descending Thoracic Aorta (e.g., Aneurysm, Pseudoaneurysm, Dissection, Penetrating Ulcer, Intramural Hematoma, or Traumatic Disruption); Not Involving Coverage of Left Subclavian Artery Origin, Initial Endoprosthesis plus Descending T

Summary

Endovascular repair of the descending thoracic aorta is a minimally invasive procedure to fix issues such as an aneurysm or tear in the aorta. This involves placing a stent graft to reinforce the artery wall without covering the left subclavian artery, which supplies blood to the left arm.

Purpose

• Medical Condition: Addresses conditions like aneurysms, pseudoaneurysms, dissections, penetrating ulcers, intramural hematomas, or traumatic disruptions in the descending thoracic aorta.
• Goals: To stabilize the affected section of the aorta, prevent rupture, and improve blood flow.

Indications

• Symptoms: Persistent chest pain, back pain, or symptoms of compromised blood circulation.
• Conditions: Diagnosed aortic aneurysm, dissection, or traumatic disruption via imaging studies.
• Criteria: Suitable anatomy for endovascular stent placement and overall patient health that supports undergoing the procedure.

Preparation

• Instructions: May include fasting for 6-8 hours before the procedure and stopping certain medications like blood thinners.
• Diagnostics: Pre-procedure imaging like CT scans or MRIs to evaluate the aorta.

Procedure Description

1. Anesthesia: Patient is given general anesthesia or local anesthesia with sedation.
2. Incision: A small incision is made in the groin area to access the femoral artery.
3. Guidewire Insertion: A guidewire is threaded through the femoral artery to the site of the aortic problem.
4. Stent Graft Placement: A catheter delivering the stent graft is navigated to the affected aorta. The stent is deployed to span the damaged section.
5. Confirmation: Imaging techniques like fluoroscopy are used to ensure proper placement.
6. Closure: Incision sites are closed, and sterile dressings are applied.

Duration

Typically takes about 2-4 hours.

Setting

Performed in a hospital's operating room or an advanced interventional radiology suite.

Personnel

• Vascular surgeons or interventional radiologists
• Anesthesiologists
• Surgical nurses and technologists

Risks and Complications

• Common Risks: Bleeding, infection, and reaction to anesthesia.
• Rare Risks: Stent migration, endoleak (blood leaking outside the graft), kidney damage, or spinal cord injury.

Benefits

• Minimally invasive with a quicker recovery time compared to open surgery.
• Reduced risk of complications such as infection.
• Stability of the aorta segment and reduction of symptoms.

Recovery

• Care: Monitoring in the ICU initially, followed by observation in a regular hospital room.
• Instructions: Limited physical activity, wound care, and avoiding heavy lifting for a few weeks.
• Follow-up: Regular imaging tests to ensure the graft is functioning properly.

Alternatives

• Open Surgical Repair: Involving a large incision and direct repair of the aorta.
• Medical Management: For patients who cannot undergo surgery, involving blood pressure control and regular monitoring.

Pros and Cons:

• Open Repair: Longer recovery, higher risk but may be necessary for unsuitable anatomy for endovascular repair.
• Medical Management: Less invasive but does not correct the underlying problem.

Patient Experience

• During: While under anesthesia, the patient will not feel anything during the procedure.
• After: Mild discomfort or groin pain at the incision site, managed with pain medication. Possible mild, temporary restriction on certain activities.

Pain management strategies and support from healthcare providers ensure a comfortable recovery period.