What you need to know about:

Endovascular Aortic Aneurysm Repair (EVAR) or Thoracic Endovascular Aortic Aneurysm Repair (TEVAR)

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Recovery Period:
3-5 days in hospital
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Overview of

Endovascular Aortic Aneurysm Repair (EVAR) or Thoracic Endovascular Aortic Aneurysm Repair (TEVAR)

in Thailand

Endovascular aortic aneurysm repair (EVAR) is a surgery used to treat an abdominal aortic aneurysm (AAA). For a patient with a thoracic aortic aneurysm (aneurysm in the chest area), the procedure is termed thoracic endovascular aortic aneurysm repair (TEVAR).  Endovascular is a term that refers to “inside the blood vessels.” An aneurysm is the bulging or ballooning of a weakened area of a blood vessel. The wall of the aorta (the largest blood vessel in the body) can become weak due to; age, high blood pressure, disease or trauma. This may cause the aortic wall to bulge, leading to an aortic aneurysm. As the bulge grows, the wall of the aorta becomes weaker. This may cause the aorta to rupture and lead to massive internal bleeding.  A ruptured aneurysm requires immediate medical attention. In most cases, patients have no symptoms. However, for those patients with symptoms, the most common are pain in the abdomen, back, or chest.

Goals of

Endovascular Aortic Aneurysm Repair (EVAR) or Thoracic Endovascular Aortic Aneurysm Repair (TEVAR)

Both EVAR and TEVAR procedurse involves the placement of a covered stent (a metal mesh tube with a layer of fabric) into the weakened area of the artery. This helps reinforces the weak spot in the aorta. By sealing the area tightly with your artery above and below the aortic aneurysm, the graft allows blood to pass through it without pushing on the aneurysm. This provides a route for the blood to flow without pooling in the bulge.

Price of

Endovascular Aortic Aneurysm Repair (EVAR) or Thoracic Endovascular Aortic Aneurysm Repair (TEVAR)

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Pros and cons of

Endovascular Aortic Aneurysm Repair (EVAR) or Thoracic Endovascular Aortic Aneurysm Repair (TEVAR)

Pros

-An endovascular repair isn't an open surgery. So it doesn't have the risks or complications of a major surgery, and the recovery time is shorter.

Cons

-Complications include bleeding, infection, and problems with the stent graft. A common complication is a leak around the stent graft.

How It Works:

Endovascular Aortic Aneurysm Repair (EVAR) or Thoracic Endovascular Aortic Aneurysm Repair (TEVAR)

Endovascular aortic aneurysm repair (EVAR) or thoracic endovascular aortic aneurysm repair (TEVAR) is performed by making two small incisions in the groin and threading two catheters through the patient’s arteries. The surgeon inserts a stent graft into the arteries through these incisions and positions it inside the aorta.

Preparation before

Endovascular Aortic Aneurysm Repair (EVAR) or Thoracic Endovascular Aortic Aneurysm Repair (TEVAR)

Pre - treatment

In preparing for surgery your doctor will explain your heart condition, the reason for surgery, the risks associated with the procedure, and the pros and cons of the surgery. Furthermore, please note the following: It is recommended that patients visit their dentist to treat any problems with their teeth and gums as these can cause infection after the surgery. It is important that you tell your dentist that you have heart disease so they can prescribe antibiotics before and after the dental procedures. Avoid drinking alcohol and smoking cigarettes for at least one month before the surgery. If you have a history of bleeding easily or clotting problems, or if you or family members have ecchymoses (discolorations on the skin due to bleeding), please inform the doctor. Avoid certain medications for five to seven days, including anticoagulants and certain heart medication, as recommended by your doctor. Please inform your doctor about any drug allergies and/or other allergies you have.

Recovery after

Endovascular Aortic Aneurysm Repair (EVAR) or Thoracic Endovascular Aortic Aneurysm Repair (TEVAR)

Post - treatment

After the procedure, the patient may be required to lay flat for 4-6 hours. This will allow the leg wounds to start healing. Some mild discomfort may be felt at the wounds in the groin. Ask your health care team when you can shower, return to work, and resume other normal activities. Avoid strenuous activities and heavy lifting for about one month after surgery. The patient can expect to stay in the hospital for 3-5 days.

Risks & side effects

The possible complications of endovascular repair include: -Leaking of blood around the graft, known as endoleak -Stent fracturing -Blockage of the blood flow through the graft -Infection -Delayed aneurysm rupture -Renal failure (2%) -Deep vein thrombosis (DVT) -Blocked blood flow to the abdomen or lower body -Death is the worst sceanria

FAQs:

Endovascular Aortic Aneurysm Repair (EVAR) or Thoracic Endovascular Aortic Aneurysm Repair (TEVAR)

What is the aorta and how does an aortic aneurysm occur?

The aorta is the biggest blood vessel that carries blood from the heart to the rest of the body. The aorta starts from the top of left ventricle (the heart pumping chamber) ascending for short distant then arches in the upper portion of the chest and down inside the chest to reach the abdomen, then divides into legs arteries.  The aorta is dividing into different parts depending on its location in the chest. They include; the ascending aorta, arch of aorta, and descending aorta.   The portion of the aorta in the abdominal cavity is called abdominal aorta. An aneurysm is an enlargement (or dilatation) of the aorta and it is usually due to aortic wall weakening creates by a process call atherosclerosis.  The causes of atherosclerosis are history of smoking, high blood pressure, high cholesterol levels, diabetes mellitus and genetics factors.  The abdominal aorta is the most common site for the aneurysm to develop. Patients may have been unaware that they have an aneurysm because it often does not cause any symptoms. However, if the aneurysm is too big then the wall becomes thin and the aneurysm can tear/break/rupture. This is usually fatal. As the aneurysm gets bigger, the risk of rupture increases. Once the aneurysm reaches a size greater than 5.5 centimeters in diameter or a rapid enlarging aneurysm, a surgical (or endovascular) repair the condition is recommended as the risks of rupture are greater than the risk associated with the repair procedures.

Who is a candidate for EVAR or TEVAR?

You may be eligible for endovascular stent grafting if your thoracic aneurysm has not ruptured and the aneurysm is 5 centimeters or more in size.  Your physician can determine if aortic aneurysm repair is the best treatment by performing one or a combination of imaging studies, which may include:  -High resolution, computed tomography (CT) scan -Magnetic resonance imaging (MRI) -Angiography (an x-ray of the blood vessels) -Transesophageal echocardiography (TEE), to record ultrasound images of your heart from inside your esophagus, or food pipe -Intravascular ultrasound  Physical characteristics of the aorta and the aortic aneurysm itself are very important in determining if endovascular aorta repair is the best treatment.

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