Question

Endovascular Repair Of Thoracic Aortic Aneurysms!

Dr.Amar Nath Shaw · Accepted Answer

The aorta is the largest blood vessel that supplies pure, oxygenated blood to the various parts of the body. Starting in the left lower heart chamber, it takes a U-turn down to the abdominal area and then the legs. It branches as it goes down, with two main branches being the thoracic and abdominal aorta.

Thoracic aortic aneurysm, also known as thoracic aortic dissection or descending aortic aneurysm is abnormal swelling of the aorta in the chest which can rupture over a period of time. The exact cause as to why this occurs has not been identified yet. Family history does have a role to play along with smoking, and history of heart disease, identified as risk factors.
The condition is quite slow to progress and often gets diagnosed when some other disease is being investigated. There are no clear symptoms to indicate this aneurysm, other than a probable hoarseness of voice, difficulty swallowing or pain in the shoulder blades. This is often due to the pressure it exerts on the surrounding areas.

Diagnosis, as noted above, is often when some other condition is being investigated. It can be identified on an x-ray and then further confirmed with MRI or CT scan.

Treatment is often decided based on the overall severity of an aneurysm and the condition of the patient. In most cases, the doctor might decide to wait and watch. The patient is monitored at regular intervals to ensure no symptoms develop and the condition is under control. Every once in 6 months, a scanning can be done to ensure that the aneurysm is not growing. The idea is to prevent rupture and internal bleeding, which can be life-threatening. Thoracic aortic endovascular graft repair, often referred to as TEVAR, is the most widely used technique for definitive treatment of a thoracic aortic aneurysm.

Treatment: What happens during TEVAR is that an aneurysm is identified and isolated. An incision is made in the groin area through which a small device is placed in the aorta at the area of an aneurysm. The part of the aorta with the aneurysm is replaced with a graft, so that normal blood flow is restored. Alternately, the blood flow could be bypassed to skip the aneurysm and flow through an alternate route.
This is a minimally invasive procedure and done as an outpatient than the conventional open heart surgeries that were done earlier.

Postop care:
- Maintain good control over blood pressure
- Watch out for recurrence, especially if there is a strong family history
- Quit smoking

Thoracic aortic aneurysms are very rare and not easy to identify. However, given the possible complications, they require timely intervention.

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