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Disease Information : Thoracic Aortic Aneurysm : Treatment

Thoracic Aortic Aneurysm : Treatment

How is Thoracic Aortic Aneurysm treated?

The treatment options for a TAA are largely dependent on the size of the aneurysm, whether it is causing symptoms, and where the aneurysm is located. For example, if the TAA is in the ascending aorta (the first portion of the aorta as it goes out from the heart) or in the transverse arch (the second part of the aorta which gives off branches to the head, neck and arms), then the only treatment available is surgery. This procedure involves opening the chest, just like for patients having heart bypass surgery, and replacing the diseased aorta with a Dacron graft, which is a synthetic (man-made) material, used to replace normal body tissues. Experimental treatments with stent grafts for a TAA are available only in highly specialized research centers. If the TAA is located in the descending aorta (the third part of the aorta that starts in the upper chest and ends at the diaphragm), there are two options available: the conventional open repair with a Dacron graft or the stent graft repair.

When a patient undergoes the open TAA repair, the procedure is performed under general anesthesia. The left side of the chest is opened and the surgeon sews a Dacron graft to replace the diseased part of the aorta. This serious operation carries a mortality rate of five to 10 percent in the best centers. There are also many complications that can occur with this operation, such as paralysis, kidney failure, pneumonia, wound infections and blood clots. Many of the patients who need a TAA repair have other chronic illnesses putting them to be at higher risk for complications.

Since 2005, many centers in the United States have been able toofferpatients a newer method of repairing a TAA which is called thoracic
endovascular aneurysm repair (TEVAR). In this procedure, instead of opening the chest to sew in a graft, a stent graft is placed through an incision in the groin across the aneurysm to treat the diseased aorta. This procedure can be performed in less time, with less blood loss, a shorter hospital stay and faster recovery. The procedure has to be done by specialists trained to perform this, and it requires special x-ray imaging to place the graft. Not every patient can undergo this type of procedure. In many cases, additional preparatory procedures have to be performed to facilitate TEVAR. Once the procedure is completed, patients still need to see their physician for follow-up x-rays to make sure that the stent graft is still working properly. Because this is a relatively new procedure, the durability of TEVAR is not clear as there is not yet long-term follow-up information on patients treated with this approach (i.e., over 10 to 15 years). There are some patients who may be too ill to be considered for any type of repair.

*All Image(s) reproduced by permission from the Society for Vascular Surgery®.

Thoracic Aortic Aneurysm section was last modified: December 21, 2010 - 06:06 pm

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