Welcome, everyone! I hope life has been treating you well. Today, we’re diving into Thoracic endovascular aortic repair (TEVAR), a minimally invasive procedure that repairs damage to the aorta in your chest. That has a higher survival rate than open surgery. About 98% of people survive the TEVAR procedure, while about 88% to 94% survive open surgery.
What is a thoracic endovascular aortic repair (TEVAR)?
Thoracic endovascular aortic repair (TEVAR) is a minimally invasive procedure to treat the upper part of your aorta. Imagine your aorta is like a large water pipe in your home, and an aneurysm is a weak spot in the pipe that’s bulging out. If the pipe bursts, it could flood your house and cause serious damage. TEVAR is like inserting a sturdy inner tube (a stent graft) into the pipe to reinforce the weak area, allowing water to flow safely without putting pressure on the damaged wall.
What does TEVAR treat?
Its main use is for Aortic Aneurysm which was the first FDA use approved however through the years this procedure has been found useful for traumatic aortic transection which is a deceleration injury of the aorta in a car crash, it has also been studied for aortic dissections if we go to the pipe example a dissection is when a small tear forms in the inner lining of the pipe, causing water to leak between the layers of the pipe wall. This creates a false channel where water gets trapped and disrupts the normal flow. TEVAR for type B dissection is like inserting a long, durable liner (stent graft) into the pipe to seal off the tear. This stops water from leaking into the layers and ensures it flows smoothly through the main channel, reducing pressure on the damaged wall and preventing further damage. In type A dissection can also be an option in selected patients but right now, it is not the main option and has not been well studied.
Who is a candidate for TEVAR?
Thoracic aortic aneurysms that are large or growing rapidly
Type B dissections (those in the descending thoracic aorta) that cannot be managed with medication therapy
An aortic tear due to traumatic injury
TEVAR is an option for people who are unable to tolerate open surgery due to their age or other health conditions.
What happens during TEVAR?
Since TEVAR is a minimally invasive procedure this means it's made by a small cut and these are the steps.
Anesthesia is given to prevent pain and numb the body.
A small incision is made by a surgeon in the groin area as well as the arm to get into the aorta. A thin tube (catheter) called a sheath will be placed in the artery.
A stent graft will be placed at the end of the catheter. The stent graft is a tube made of a thin metal mesh (the stent), It's covered with a thin polyester fabric (the graft).
Using X-rays as a guide the stent will be placed and expanded
The catheter will be removed and the incision closed.
What are the risks of TEVAR?
TEVAR risks include infection, bleeding, and graft complications. Traditional surgery may be needed, and aneurysms can recur.
What happens after TEVAR?
After the procedure, you will spend several hours in the intensive care unit, so the team will closely watch your heart rate, blood pressure, and breathing. To help prevent bleeding, you may need to lie flat for several hours after the procedure.
Fun Fact: The first TEVAR was performed in 1986
This is all we have for you today folks. We hope this has been informative. Join us back here next Tuesday.
-Alvaro Jose Martinez
Bibliography
[1] Thoracic endovascular aneurysm repair (TEVAR): What you need to know. Cleveland Clinic n.d. https://my.clevelandclinic.org/health/treatments/16962-endovascular-repair-of-thoracic-aortic-aneurysms (accessed January 20, 2025).
[2] Thoracic endovascular aortic repair. Hopkinsmedicine.org 2024. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/thoracic-endovascular-aortic-repair (accessed January 20, 2025).
[3] Thoracic endovascular aneurysm repair (TEVAR). Umcvc.org n.d. https://www.umcvc.org/conditions-treatments/thoracic-endovascular-aneurysm-repair-tevar (accessed January 20, 2025).
[4] Endovascular repair of the thoracic aorta. Uptodate.com n.d. https://www.uptodate.com/contents/endovascular-repair-of-the-thoracic-aorta (accessed January 20, 2025).
[5] Nation D, Wang G. TEVAR: Endovascular repair of the thoracic aorta. Semin Intervent Radiol 2015;32:265–71. https://doi.org/10.1055/s-0035-1558824.
[6] Nienaber CA, Sakalihasan N, Clough RE, Aboukoura M, Mancuso E, Yeh JSM, et al. Thoracic endovascular aortic repair (TEVAR) in proximal (type A) aortic dissection: Ready for a broader application? J Thorac Cardiovasc Surg 2017;153:S3–11. https://doi.org/10.1016/j.jtcvs.2016.07.078.
[7] Chen SW, Lee KB, Napolitano MA, Murillo-Berlioz AE, Sattah AP, Sarin S, et al. Complications and management of the thoracic endovascular aortic repair. Aorta (Stamford) 2020;08:049–58. https://doi.org/10.1055/s-0040-1714089.
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