TREATMENT: TRANSTHORACIC ENDOVASCULAR AORTIC REPAIR (TEVAR)

The procedure is carried out in the cardiac surgery operating room under x-ray fluoroscopy guidance. The procedure is usually performed with the patient fully asleep (general anaesthetic). The access to the aorta is gained by a poke in the femoral arteries in the groin. Guidewires and catheter are inserted into the groin and passed through the arteries up to the aorta.
Illustration of stent graft being deployed to treat a descending thoracic aneurysm. Access is obtained via a small groin incision.
Throughout the procedure, x-ray and ultrasound images help the surgeon guide the devices to the appropriate site. The graft can be secured in place using a “ballooning” technique., where the surgeon expands a small balloon inside the ends of the grafts to ensure it is firmly adhered to the healthy aortic wall (landing site) and then the catheter is pulled back leaving the endograft in place and the diseased section of the aorta is contained. Once the graft is placed and secured, the blood flow is established through this structure and not into the surrounding aneurysm sac, thus taking off the pressure of the aneurysm sac.

Left: CT image of descending thoracic aneurysm before TEVAR procedure.
Right: CT image after minimally invasive TEVAR procedure. Note the aneurysm sac has been successfully excluded from blood flow.
