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Thoracic aortic aneurysms (TAA) affect approximately 15,000 people in the United States each year. Thoracic aortic aneurysms are a serious health risk because they can burst or rupture, leading to internal bleeding and, possibly, shock or death. For this reason, it is crucial to treat large aneurysms early, in order to prevent their rupture.
If your TAA is small and not causing symptoms, your physician may recommend "watchful waiting," which means that you will be monitored every 6 months for signs of changes in your aneurysm. Your physician may schedule you for CT or MRI scans every 6 months to watch the aneurysm.
Open Surgical Repair In surgical aneurysm repair, your surgeon repairs or removes an aneurysm through an incision in your skin. Depending upon the type and location of the aneurysm, your surgeon may repair or replace your artery affected by an aneurysm using tissues from your body or synthetic fabric patches or tubes called grafts. Less commonly, your surgeon may use clips or clamps to stop blood from flowing into your aneurysm.
Before the procedure
- Your physician will ask you about your medical history and perform a complete physical examination
- Your physician may also perform several tests, including an electrocardiogram (ECG), a spiral computed tomography (CT) scan, angiography and stress testing
- Usually, you will be asked not to eat or drink anything at least eight hours before your procedure
- Your doctor will discuss with you whether to reduce or stop any medications that might increase your risk of bleeding or other complications
During the procedure
- You will be given an anesthetic to eliminate pain during your aneurysm operation
- Your vascular surgeon will make an incision in your skin and muscle over the artery with the aneurysm
- Once the aneurysm site is exposed, your surgeon will clamp the artery above the aneurysm to stop blood from flowing through the area
- Your surgeon next opens the aneurysm and removes the clotted blood and plaque deposits
- Depending upon the location of the aneurysm, your surgeon often will not completely remove the aneurysm. Instead, he or she may choose to cut through the wall of the weakened artery and open it like a butterfly in order to then insert a graft that is the same size and shape of your healthy artery. Your surgeon will attach one end of this graft by sewing it to the healthy artery just above where the aneurysm begins and sewing the other end to your normal artery below the end of the aneurysm
- Another less common option is for your surgeon to attach a fabric patch to the artery wall to decrease its size and strengthen it
After the procedure
- You may need to stay in the hospital for about seven to 10 days until you are recovered enough to go home
- Depending upon the location of your incision and your general health, you may require care in intensive care until you recover sufficiently
- Your doctor or vascular surgeon will give you the instructions you need to follow after the surgery, such as not lifting anything more than 10 to 15 pounds, until your incision heals adequately
- Depending upon its location, your doctor may schedule you periodically for an imaging study to ensure that your aneurysm is not redeveloping and that the graft, patch or clips are functioning correctly
Endovascular Stent Graft Repair An endovascular stent graft is composed of fabric supported by a metal mesh called a stent. It can be used for a variety of conditions involving the blood vessels, but most commonly is used to reinforce an aneurysm. The stent graft is designed to seal tightly with your artery above and below the aneurysm. The graft is stronger than the weakened artery and it allows your blood to pass through it without pushing on the bulge.
Before the procedure
During the procedure
- You will usually receive a sedative and a regional anesthesia, or you might receive general anesthesia depending upon your particular circumstance
- Your vascular surgeon will then cut into the skin overlying the femoral artery in your groin
- Your vascular surgeon threads a guide wire into your femoral artery and advances it to the aneurysm. Because you have no nerve endings inside your arteries, you will not feel the wires or catheters as they move through your body. You may feel a slight pressure or a sensation of mild tugging during this insertion
- Using X-rays that appear as moving images on a screen, your vascular surgeon inserts a catheter over the guide wire
- Usually your vascular surgeon will perform angiography through the catheter to insure correct placement of the endovascular stent graft. You may feel a warm sensation as the contrast dye is injected
- A compressed form of the graft is inserted through a larger catheter, called a sheath, and the guide wire carries so it can move through your blood vessels. When the graft has reached the aneurysm site, your physician withdraws the sheath, leaving the graft in place. The graft expands to fit snugly against the walls of your artery
After the procedure
- Usually you will spend two to three days in the hospital
- During the first recovery day you will be permitted to eat and encouraged to walk
- After you leave the hospital, you should not drive until your physician gives approval
- You may be permitted to sponge bathe around your incisions but you should avoid soaking your incisions until they have healed
- You may also be advised to avoid lifting more than about five to 10 pounds for approximately four to six weeks after the procedure
- Your physician will instruct you to return for a follow-up visit within the first few weeks after your procedure. At that visit, your physician will check your incisions and assess your overall condition
Usually you will undergo follow-up imaging tests within the first few months after the procedure to ensure that the stent is still functioning without significant problems and in the proper location. After the first year, you will probably undergo yearly imaging tests if your aneurysm is shrinking and no problems are found. You may require more frequent imaging tests if potential problems require closer monitoring.
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Less serious complications that you may experience following TAA repair surgery include:
- Swelling
- Respiratory or urinary infections
Infections at the incision site
More serious complications that you may experience after open surgery include:
- Heart problems
- Breathing problems
- Kidney problems
- Colon problems
Possible complications of endovascular stent grafting include:
- Leaking of blood around the graft ("endoleaks")
- Infection
- Movement of the graft away from the desired location ("migration")
- Graft fracturing
- Blockage of the blood flow through the graft
If you suspect or experience any complications because of the endovascular stent graft as described above, you should contact your physician immediately. |
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