Thoracic Endovascular Aortic Repair

What is thoracic endovascular aortic repair (TEVAR)?

Thoracic endovascular aortic repair (TEVAR) is a procedure to treat an aneurysm in the upper part of your aorta. The aorta is your body’s largest artery. An aneurysm is a weak, bulging area in the aorta wall. If it bursts (ruptures), it can be deadly.

TEVAR is a minimally invasive surgery. That means it's done with a small cut (incision). With TEVAR, a device called a stent graft is used to reinforce the aneurysm. A stent graft is a metal tube covered in fabric. It helps prevent the aneurysm from bursting.

Why might I need a TEVAR?

The aorta is your body’s largest artery. It carries oxygen-rich blood from your heart to the rest of your body. It goes from your heart through your chest and into your belly (abdomen). It then divides into blood vessels that provide blood flow to your legs.

Sometimes a weak area of the aorta bulges out. This is called an aortic aneurysm. An aneurysm of the aorta is serious because it can tear (dissection) or burst (rupture). The risk of bursting grows as the aneurysm gets bigger. Treatment depends on the size of the aneurysm. Treatment also depends on how fast the aneurysm is growing.

Your healthcare provider may advise TEVAR to fix an aneurysm in the part of the aorta that is in your chest. This is called the thoracic area.

What are the risks of TEVAR?

As with any procedure, problems can occur. Some possible complications may include:

• Infection

• Bleeding

• Injury to nearby organs

• Blood clots

• Stroke

• Risks from anesthesia

• Kidney damage from dye used during the X-ray when the stent graft is put in place

• Device or delivery failure

• Blood vessel injury

• Leaking graft

• Paralysis

• The graft moves out of place

• Loss of a leg

• Traditional open surgery may be needed

• Your aortic aneurysm may keep growing after surgery

• Graft infection

You may have other risks depending on your health. Talk about any concerns with your healthcare provider before the procedure.

How do I get ready for TEVAR?

Ask your healthcare provider to tell you what you should do before TEVAR. Below is a list of common steps that you may be asked to do:

• Your healthcare provider will explain the procedure to you. Ask any questions you may have.

• You will be asked to sign a consent form that gives permission to do the procedure. Read the form carefully and ask questions if anything is not clear.

• Your healthcare provider will take your medical history and may give you a physical exam. This is to be sure you are in good health before the procedure. You may also have blood tests and other diagnostic tests.

• Tell your provider if you are pregnant or think you may be pregnant.

• Tell your provider if you are sensitive to or are allergic to any medicines, latex, iodine, tape, contrast dyes, and anesthesia medicines (local and general).

• Tell your provider about all the medicines you take. This includes both over-the-counter and prescription medicines. It also includes vitamins, herbs, and other supplements.

• Your healthcare provider may prescribe medicines to take in the days before your surgery. These medicines can help relax blood vessels, lower blood pressure, and reduce the risk of your aortic aneurysm bursting.

• If you take any blood-thinning medicines like warfarin or aspirin, tell your healthcare provider before your surgery. These can raise your risk of bleeding during the procedure. You may need to stop taking these before the procedure to reduce your bleeding risk.

• You will likely be told not to drink or eat anything for several hours before surgery. This often means no food or drink after midnight before your surgery. Ask if you can take medicines during this time with sips of water.

• If you smoke, stop smoking as soon as possible before surgery. This can improve your chances for a successful recovery from surgery. It can also improve your overall health.

Your healthcare provider may have other instructions for you based on your medical condition.

What happens during TEVAR?

TEVAR is a minimally invasive procedure. This means it is done with a small cut (incision). A vascular surgeon and a team of specialized healthcare providers will do the surgery. Your surgeon can explain what to expect for your surgery. This is an example of how it's done:

• You will be given anesthesia to prevent pain. This may be general anesthesia, which causes you to sleep through the procedure. Or it may be regional anesthesia, which numbs a certain part of your body.

• A healthcare provider will carefully watch your vital signs, like your heart rate and blood pressure, during the procedure.

• Your surgeon may make a small incision in the groin area as well as the arm to get into the aorta. A thin tube (catheter) called a sheath will be placed in the artery.

• Your surgeon will attach a stent graft to the end of the catheter. The stent graft is a tube made of a thin metal mesh (the stent). It's covered with a thin polyester fabric (the graft). The tube is collapsed so it's narrow and can fit through your blood vessel.

• Using X-rays as a guide, your surgeon will thread the catheter, with the stent graft attached, through an artery in your groin to the affected part of your aorta.

• Once the stent graft is in place, your surgeon will expand its metal frame and fasten it into place.

• The metal frame expands like a spring and attaches tightly to the wall of your aorta. This provides a stable place for blood to flow. It also stops the aneurysm from tearing or bursting. The blood supply is now cut off from the aneurysm. This makes the aneurysm shrink over time.

• Your surgeon will remove the catheter. They will close the incision and put a small bandage on the wound.

What happens after TEVAR?

After the procedure, you will spend several hours in a PACU (postanesthesia care unit). Your healthcare team will closely watch your heart rate, blood pressure, and breathing. To help prevent bleeding, you may need to lie flat for several hours after the procedure.

After surgery, expect to stay in the hospital for at least 3 to 4 days. Your healthcare provider will tell you more about what to expect.

Plan to have an adult family member or friend drive you home when you leave the hospital.

Recovering at home

• Recovery time from TEVAR is shorter than it is from traditional open surgery (larger incision) for an aortic aneurysm.

• Don't do strenuous activity for at least 4 weeks. Ask your healthcare provider when it may be safe to drive again. Check your incision site for signs of infection. These include redness, swelling, pain, drainage and a bulge.

• Report a fever of 100.4°F (38.0°C) or higher to your healthcare provider right away.

• You may need CT scans at regular intervals. These will check for leaks, any breakdown of your graft, and other problems.

• Your provider may tell you when to restart or to start taking blood-thinning medicines to prevent blood clots.

• Ask your provider what types of foods to eat and not eat. The recommended diet will depend on all of your healthcare needs.

• Your healthcare team will tell you when to schedule your follow-up appointment to check your progress and recovery.

• Remember to take all your medicines as prescribed.

Your healthcare provider may give you other instructions.

Next steps

Before you agree to the test or procedure make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how you will get the results

• Who to call after the test or procedure if you have questions or problems, including the number to call after office offices, weekends, and holidays.

• How much you will have to pay for the test or procedure