A Thoracic Endovascular Aortic Repair (TEVAR) is done to repair the aorta through a minimally-invasive technique. The aorta is the largest vessel in the human body which is responsible for carrying blood from the heart to other organs of the body. Once the aorta exits the heart, it reaches to the arms and brain before going to the abdomen through the back of the chest. Upon reaching the belly button, the aorta branches down to the legs – to supply blood throughout the organs.
TEVAR is performed to treat an aneurysm that has formed in the weak area of the aorta, especially the upper part of it – the chest. This is called an aortic aneurysm. An aneurysm is a weak, protruding area in the wall of the aorta, which if bursts can prove to be fatal for the person. The risk of the aorta bursting increases as the aneurysm gets bigger. Hence, it is very important to repair the aorta. The TEVAR procedure only requires the surgeon to make a small incision and place a stent-graft to reinforce the aneurysm and prevent it from rupturing.
Risks of TEVAR
TEVAR is a minimally-invasive and effective procedure; however possible risks can occur. Some risks include:
- Blood clots
- Damage to nearby organs or blood vessels
- Leakage of graft
- Loss of a leg
- Failure of device
- Kidney problems from the special dye used in X-Ray
- Allergic reactions to the special dye
In some cases, the aneurysm can continue to grow in size even after the surgery, which would imply a need for another surgery or an alternative course of treatment. On the other hand, in some cases, a TEVAR may not be very effective and the patient might have to undergo traditional open surgery.
Other risks and complications of the procedure vary per case depending on the existing medical conditions and age of the patient.
Procedure of TEVAR
Before the procedure, the doctor will conduct several diagnostic tests and enquire about allergies, on-going medications, etc. Moreover, the doctor will also prescribe certain medicines to be taken before the surgery to help relax the blood vessels, lower blood pressure, etc. The patient will be advised to not drink or eat anything, as well as stop smoking several hours before the procedure.
During the procedure, the patient will be given anaesthesia to prevent pain and the doctor will monitor the general health indication before beginning the surgery. Once satisfied, the surgeon will make a small incision in the groin and the arm to place a thin tube called a catheter inside the body to repair the aneurysm of the aorta.
Once the catheter is in place, the surgeon will attach a stent (thin metal mesh tube) at the end of the catheter; this is covered with the graft made of thin polyester fabric. After this, the surgeon uses the X-Ray images to thread the catheter to the affected part of the aorta by entering an artery in the groin. Once the catheter with the stent-graft is in place, the surgeon will fix the graft in the affected area by widening its metal frame which sticks to the wall of the aorta firmly.
Placing the stent promotes stability of blood flow, as well as prevents the aneurysm from rupturing. In the final step, the surgeon cuts the supply of blood to the aneurysm, causing it to shrink over time. The catheter is then removed from the patient’s body and the incision is closed and bandaged.
Recovery after TEVAR
After the procedure, the patient is kept in the recovery for some hours and monitored for vital health signs stability such as heart rate, breathing, blood pressure, etc. Once stabilised, the patient is shifted to the room and kept under observation for 3-4 days to ensure a healthy recovery. Once discharged, the doctor will advise on the precautions and recovery methods to be adopted at home.
- The patient would be asked to refrain from any strenuous activity for at least a month after being discharged.
- The patient should monitor the incision site for any infections, bleeding, blood clots, pain, swelling, etc.
- Any case the patient gets a fever; the doctor must be immediately informed
- Follow-up check-ups will be scheduled to check the status, recovery and leakage of the graft
- The doctor would suggest the diet and lifestyle alterations post the surgery
- The patient must take all prescribed medicines timely
Any other precautions or safety measures will be advised by the doctor as per the case and the patient’s condition post-surgery.
That said, TEVAR is a very safe and effective procedure to treat uncomplicated cases of an aneurysm in the aorta. However, the patient must discuss all relevant details and gather in-depth information about the procedure before going ahead with TEVAR.