Descending thoracic aneurysms are located in the back part of the chest.  Open surgery involves a large incision in the back and side of the left chest. Ribs are spread. One or more ribs may need to be removed to allow access to the entire aorta from the arch to the diaphragm.  The aneurysmal part of the aorta is replaced with a Dacron graft.

DescendingThoracicAorticReplacementCartoon-2005CircIsselbacherIllustration of open descending thoracic aortic replacement. The aorta is divided and a surgical Dacron interposition graft is sewn in.  Access is via a large cut in the left side of chest.


Apart from the usual risks of cardiovascular surgery, operating on the descending thoracic aorta involves a risk of paralysis. Part of the blood supply to the spinal cord arises off the thoracic aorta which is being excluded in this type of surgery.  Various surgical adjuncts are used to minimize the risks of paralysis and stroke.

DTA with recurrent laryngeal nerve

Intraoperative photograph of descending thoracic aneurysm. Note the aorta is about 3 times normal size.