Thoracic Aortic Aneurysm Surgery

Overview

Surgery is the recommended treatment for addressing a bulge or aneurysm in the thoracic aorta, the section of the aorta that runs through the chest. The aorta is the large artery responsible for distributing blood from the heart throughout the body. It begins at the heart, traverses the chest and abdomen, and terminates at the pelvis.

Aneurysm can develop when a weak spot forms in one of the arteries. This weakness can lead to the artery enlarging or ballooning. It’s worth noting that thoracic aortic aneurysms are quite rare, affecting fewer than 1 in 10,000 individuals.

Types of thoracic aortic aneurysm surgery

A thoracic aortic aneurysm can be treated with one of two methods:

• Open thoracic aneurysm repair. An open procedure involving a lengthy incision down the side of your chest. The injured section of the aorta is removed by your surgeon and replaced with a synthetic substance (graft).
• Thoracic Endovascular Aortic Repair (TEVAR). A treatment with minimal invasiveness. A tiny, hollow tube called a catheter is inserted by your surgeon into a blood vessel in your groin to access your aorta. A tiny mesh device called a stent is inserted via the catheter to fix the damaged section of the aorta and enable appropriate blood flow.

Reasons for undergoing the procedure

Not every patient with a thoracic aortic aneurysm requires surgery. The size of the aneurysm, your symptoms, and your general health will all determine whether you require surgical treatment.

In order to minimize the risk of a ruptured aneurysm, your doctor may recommend thoracic aortic aneurysm surgery. It’s important to note that not all thoracic aortic aneurysms rupture, but when they do, they can be life-threatening.

Risks

Thoracic aortic aneurysm surgery significantly reduces the likelihood of a potentially deadly aneurysm rupture. When the risks associated with a rupture outweigh the risks of surgery, your doctor typically recommends undergoing the surgical procedure.

While it is a complex and serious surgical intervention, addressing a thoracic aortic aneurysm can potentially save a person’s life. Possible complications and concerns that may arise during the procedure include:

• Bleeding
• Infection
• Stroke
• Heart attack
• An interruption in the spinal cord’s blood supply
• Leg weakness
• Kidney problems
• Lung infections or other respiratory issues

Before the procedure

To determine the necessity of surgery for a thoracic aortic aneurysm, your doctor will rely on imaging studies. CT scans are commonly employed to monitor the aneurysm’s size. If the aneurysm measures greater than 5.5 centimeters or has increased by more than 0.5 cm within the past six months, your healthcare provider may recommend surgery.

Your doctor will provide you with instructions on how to prepare for the procedure. A few days before the surgery, they may prescribe medications that can relax your blood vessels or lower your blood pressure. You may also be required to discontinue the use of blood thinners, also known as anticoagulants, for a period prior to the procedure.

During the procedure

During the open repair of a thoracic aortic aneurysm, your surgeon:

• Creates a sizable incision down the side of your chest.
• Temporarily stops blood flow in the aortic section that is injured using specialized instruments.
• Uses synthetic graft to replace the damaged portion of your aorta.
• Closes the incision using stitches.

The doctor will perform the following during TEVAR:

• Places a catheter and specific wires into your groin artery.
• Leads the catheter to your thoracic aorta.
• Uses a contrast dye injection through the catheter to provide a clear view of your thoracic aorta.
• Employs CT or X-ray guidance to ensure precise stent placement.
• Withdraws the catheter and wires, then covers the groin wound with a bandage.

After the procedure

Following open surgery, you will be admitted to the intensive care unit (ICU) for immediate recovery. After a day or two, you will be transferred to another section of the hospital, where you may stay for up to ten days.

In the case of TEVAR surgery, patients typically spend about three days in the hospital. Some mild soreness and bruising may occur. If needed, your healthcare provider will prescribe medication to assist you in managing any pain.

Outcome

Most patients can resume their regular routines within two to three months after thoracic aortic aneurysm surgery. However, after open surgery, it is advisable to limit physical activities for approximately four to six weeks. With TEVAR, you can typically return to your usual activities in a few weeks, although you should still avoid strenuous physical activities for about four weeks.