TEVAR

As the largest artery, the aorta carries oxygen-rich blood from the heart to smaller arteries that branch throughout the body. The aorta’s upper section, the thoracic aorta, begins at the heart and runs through the chest. It supplies blood to the brain, arms and upper body.

An aneurysm develops when a section of artery wall weakens and thins, causing an outward bulge. Given the aorta’s strong blood flow, an aneurysm can continue to grow and may burst, causing uncontrolled internal bleeding. In people with uncontrolled high blood pressure, the excessive pressure can cause a devastating tear in the aorta’s lining, leading to an aortic dissection.

Ruptured aneurysms and aortic dissections are life-threatening emergencies that require immediate medical care. Learn more about aortic aneurysms and aortic dissections.

Doctors treating a thoracic aortic aneurysm try to prevent a rupture or dissection. If you have a small, stable aneurysm, you may need only medication and regularly scheduled, follow-up imaging to manage it. Fast-growing or large (about 2 inches or more) aneurysms require repair, with either an endovascular procedure or open surgery.

Dissections in the ascending aorta, which leaves the heart and curves into the aortic arch, are emergencies that require open surgery. Dissections in the descending aorta, which begins at the arch and runs down the chest, are often repairable with an endovascular procedure.

Not all thoracic aneurysms and dissections are treatable with an endovascular procedure. We work closely with you to decide which approach will provide you with the most effective, longest-lasting results.

What is thoracic endovascular aneurysm repair (TEVAR)?

Thoracic endovascular aneurysm repair (TEVAR) treats aneurysms and dissections in the upper aorta, providing a minimally invasive alternative to open surgery. It is a catheter procedure, meaning your surgeon uses a thin, flexible tube inserted into a needle puncture or incision in an artery.

The surgeon guides the catheter through arteries to the treatment area, then places a stent graft, a fabric-covered, metal-mesh tube. The stent graft eliminates pressure on the aneurysm, reinforcing the aorta to prevent the aneurysm from growing or rupturing. For dissections, the stent graft essentially reconstructs the section that tore.

Benefits of endovascular approach for thoracic aortic aneurysm repair

Repairing aortic aneurysms and dissections with an endovascular approach rather than open surgery can provide several benefits:

• Option for people who can’t have open surgery for various reasons
• Smaller incisions or none at all, if a needle puncture is used
• Less blood loss during the procedure
• Shorter hospital stay (two to three days)
• Faster recovery (two weeks)

Aneurysms in certain parts of the thoracic aorta are often challenging to repair with a traditional endovascular approach. These aneurysms include:

• Aortic arch aneurysms: These bulges occur where the thoracic aorta leads out of the heart, goes up slightly, then curves back down in a hairpin turn. Several arteries branch off the arch to carry blood to the brain and arms.
• Thoracoabdominal aneurysms: Aneurysms can occur between the upper and lower sections of the aorta. In this area, several branching arteries supply blood to organs such as the kidneys, liver, spleen and intestines.

At Henry Ford, our skilled vascular surgeons are developing innovative endovascular techniques to treat these complex aortic aneurysms. Our approaches include:

• Stent grafts with laser-cut openings: Our surgeons can place a stent graft in the aortic arch, then use a laser to create customized openings (fenestrations). The openings maintain blood flow to the branching arteries.
• Branched stent grafts: We’re participating in clinical trials of special stent grafts designed for the aortic arch. The grafts contain branches to avoid blocking the smaller arteries that run to the head and arms. Our surgeons can provide access to these trials if you’re eligible.
• Hybrid procedures: Some people with thoracoabdominal aneurysms are too sick for normal open surgery. But doctors are still working on an alternative that fully takes a minimally invasive approach. In the meantime, our vascular and cardiac surgeons have developed a technique that combines both approaches. This hybrid procedure reduces the burden of open surgery.

With standard TEVAR, your surgeon performs a catheter-based procedure to access the aortic aneurysm or dissection and place the stent graft. The steps include:

1. The doctor makes either a needle puncture or a small incision in an artery, typically in your groin.
2. The doctor inserts a catheter into the puncture or incision, then directs it through the artery to the treatment area.
3. The doctor guides a stent graft, a metal-mesh tube (stent) covered with thin fabric (graft), through the catheter to the aneurysm or dissection.
4. The stent graft is opened inside the damaged area and attached to the aorta.
5. The doctor checks the area for blood leaks before removing the catheter and instruments.

After TEVAR, you spend a night in the intensive care unit (ICU). You can expect a hospital stay of one or two additional nights after the procedure. You receive pain medication as needed, and your care team monitors your vital signs.

We provide instructions before you leave the hospital for at-home care. Your overall recovery time is about two weeks following the procedure.

Your first follow-up appointment typically takes place about four to six weeks after the procedure. We perform a CT scan to make sure the stent graft is in place and there are no blood leaks. Typically, you’ll need to come back in six months and 12 months, then yearly after that, for continued follow-up and monitoring.