Thoracic aortic aneurysm repair is an advanced treatment option for thoracic aortic aneurysms (TAA). Depending on your individual needs, your doctor may recommend either:
- Open surgical aneurysm repair
- Endovascular stent-graft repair
- Interventional Thoracic Aortic Aneurysm Repair
What is Open Thoracic Aortic Aneurysm 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 Open Thoracic Aortic Aneurysm Repair
- Your doctor will ask you about your medical history and perform a complete physical examination.
- Your doctor 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.
What to Expect During Open Thoracic Aortic Aneurysm Repair
- An anesthesiologist will give you an anesthetic to eliminate pain during your operation.
- Your doctor will make an incision in your skin and muscle over the artery with the aneurysm.
- Once the aneurysm site is exposed, your doctor will clamp the artery above the aneurysm to stop blood from flowing through the area.
- Next, your doctor opens the aneurysm and removes the clotted blood and plaque deposits.
- Depending upon the location of the aneurysm, your doctor 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.
What to Expect After Open Thoracic Aortic Aneurysm Repair
After open surgical aneurysm repair:
- 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.
Thoracic Aortic Aneurysm Repair Follow-Up
For both open surgical and endovascular thoracic aortic aneurysm repair, 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.
Am I a Candidate for Thoracic Aortic Aneurysm Repair?
If your thoracic aortic aneurysm is large or causing symptoms, you need active and prompt treatment. Your doctor may recommend actively treating through open surgical aneurysm repair or endovascular stent-graft repair.
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 a CT scan or MRI every six months to watch the aneurysm.
Your doctor will advise you regarding the best option for your particular situation.