The MUSC Advanced Aortic Surgery Program

Thoracic Aortic Aneurysm Repair

Thoracic Aortic Aneurysm Open Repair

The type of surgical repair of a thoracic aortic aneurysm will depend on several factors: the location of the aneurysm, the type of aneurysm, and the patient’s tolerance for the procedure.

For an ascending or aortic arch aneurysm, a large incision may be made through the breastbone (median sternotomy). If an ascending aneurysm involves damage to the aortic valve of the heart, the valve may be replaced during the procedure.Valve-sparing aortic root repair is an option for some patients, and involves replacing the diseased section of your aorta with an artificial tube (graft). The patient's aortic valve remains in place, and is sutured to the inside of the graft.

For a descending aneurysm, a large incision may extend from the back under the shoulder blade around the side of the rib cage to just under the breast (thoracotomy). These approaches allow the surgeon to visualize the aorta directly to repair the aneurysm.

The surgeon then repairs the aorta by replacing the aneurysm with a tube called a synthetic graft, which is sewn into place. Open repair remains the standard procedure for an abdominal aortic aneurysm repair. 

Thoracic Aortic Endovascular Repair (TEVAR)

Thoracic aortic endovascular repair (TEVAR) is a less invasive method for replacement of the descending thoracic aorta. Patients with significant risk factors such as chronic obstructive pulmonary disease and renal failure may not be candidates for traditional descending aortic surgery. However they might be candidates for TEVAR, where a covered stent graft is deployed from the inside the aorta, using thin, long tubes called catheters. Through small incisions in the groin, the catheters are used to guide and deliver a stent-graft through the blood vessels to the site of the aneurysm. The stent graft is then deployed in the diseased segment of the aorta and "relines" the aorta like a sleeve to divert blood flow away from the aneurysm

Certain patients with complicated aortic dissections and traumatic aortic tears also may be treated with TEVAR with excellent results.

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