How are descending thoracic aneurysms repaired?

Repair of descending thoracic aneurysms may be done through open surgery, with endovascular stent grafts, or with a combination of both procedures. Advances in surgical techniques have resulted in increased use of stent grafts in the last five years. It is important to carefully weigh all of your options by speaking to an aortic specialist.
Mark J. Russo, MD
Thoracic Surgery (Cardiothoracic Vascular)

There are three approaches of repairing for thoracic aortic aneurysms: open surgery, endovascular (TEVAR), and the hybrid approach. The type of surgical repair of a thoracic aortic aneurysm will depend on several factors, including the location of the aneurysm, the type of aneurysm, and the patient's tolerance for the procedure. 

Open repair is the standard treatment. For a descending thoracic aortic 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. 

An alternative approach for a descending thoracic aortic aneurysm repair is thoracic endovascular (TEVAR) aneurysm repair. It is similar to the approach used for a cardiac catheterization of the coronary arteries. This procedure requires only small incisions in the groin. Then the surgeon inserts a catheter through the femoral artery in the groin and with the use of x-ray guidance and specially-designed instruments, the aneurysm can be repaired from inside the aorta by inserting a tube, called a stent-graft. This is possible because the tube, or stent graft, is delivered through the catheter in a collapsed state and then expanded at the site of the aneurysm. The tube replaces and reinforces the diseased aortic wall, ensuring continuity of blood flow while preventing further expansion of the aorta, aortic rupture, and/or aortic dissection.

However, not all thoracic aneurysms can be repaired by means of endovascular stenting alone. Therefore, a third option, called a hybrid procedure uses endovascular stenting along with open surgery to take advantage of the benefits of each while minimizing the limitations and related risks. Often, hybrid procedures can be custom designed for the patient in an effort to decrease size of the incision, duration of the procedure, and avoid the need to stop blood flow to the heart and/or brain. 

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