What Is Thoracic Endovascular Aortic Repair (TEVAR)?

Thoracic endovascular aortic repair (TEVAR) is a minimally invasive surgical procedure that repairs the aorta

Thoracic endovascular aortic repair (TEVAR) is a procedure to repair the major blood vessel in the body called the aorta. It is a minimally invasive procedure in which a small incision is made for repairing the aorta. 

The aorta is the main artery of the body that exits the heart and carries blood to the rest of the body. After leaving the heart, it branches to the arms and brain before passing down the back of the chest (thoracic aorta) and into the belly (abdominal aorta). In the abdomen, the aorta forks at the level of the belly button into branches that go down each leg.

When there is an abnormal bulge in a weakened wall of the aorta in the chest area, the condition is called a thoracic aortic aneurysm. A thoracic aortic aneurysm can cause various symptoms and often life-threatening complications. 

Other conditions that may affect the aorta are tears (dissection), rupture (transection) and narrowing (stenosis) of the aorta. For the surgical repair of these conditions, especially a thoracic aortic aneurysm, TEVAR may be performed. 

• In this procedure, surgeons place a device, known as a stent graft, through a small incision in the groin. 
• The stent is generally made of a fabric-covered metal mesh that is placed under X-ray guidance. 
• The stent graft expands to fit against the walls of the aorta on either side of the aneurysm.
• The blood flows through the stent graft, avoiding the aneurysm that typically shrinks over time as the blood pressure is diverted away from the aneurysm. 
• This repairs the diseased aorta and helps to keep it open (patent) to allow blood to flow properly to the rest of the body.

The indications for thoracic endovascular aortic repair (TEVAR) are as follows:

• Descending thoracic aortic aneurysm: TEVAR is performed in people with a thoracic aneurysm that has not ruptured and is 5 cm or more in size.
• Complicated descending thoracic aortic dissection
• Focal penetrating ulcer in the thoracic aorta
• Aortic injury or trauma

Thoracic endovascular aortic repair (TEVAR) is a better approach than the conventional open surgery in many cases because it is a minimally invasive surgery wherein a small groin incision is made unlike the open repair surgery for the aorta, which requires a large incision through the breastbone or side of the chest. 

This makes TEVAR a less painful and safer alternative with fewer complications than the open repair of the aorta. In some people, however, who have extensive aortic or multiple aneurysms, the best approach may require a combination of TEVAR and open surgery. This is called a hybrid approach.

As with any surgical procedure, certain complications may arise in a thoracic endovascular aortic repair (TEVAR) surgery such as:

• Bleeding
• Endoleak (leaking of blood around the graft)
• Displacement of the graft away from its initial placement
• Stent fracturing
• Infections
• Delayed rupture of the aneurysm
• Stroke
• Paralysis
• Blood vessel injury