Have you heard of the largest and most important blood vessel in your body? We call it the aorta . Think of it like the main water pipe that carries blood throughout your body. But sometimes, the wall of this aorta weakens and starts to bulge out like a balloon. In medicine, we call this an aneurysm . It's like an old water pipe that bulges out. If this balloon bursts, it can be very dangerous for your life. But don't worry, with the advancement of medical science, there are now very effective treatments for such conditions. Today, we are talking about a special treatment method that is done without major surgery.
What exactly is TEVAR?
Simply put, TEVAR (Thoracic Endovascular Aortic Repair) is a modern, minimally invasive treatment used to repair damage to the thoracic aorta, especially aneurysms.
In the past, this condition was treated with a large, open surgery that involves opening the chest. It is very complicated, takes a long time to heal, and has high risks. But now, for patients who qualify, doctors are increasingly choosing this TEVAR procedure. It has a shorter recovery time, a lower risk of major complications, and is much more comfortable for the patient. Your doctor will determine whether this treatment is right for you based on factors such as your blood vessel anatomy.
TEVAR is not open-heart surgery. It is done internally, through a thin tube through a blood vessel. It is like repairing a vessel by inserting a new lining inside.
What conditions is TEVAR treatment used for?
Surgeons mainly use this TEVAR method for several types of damage to the aorta.
| Illness | A simple explanation |
|---|---|
| Thoracic Aortic Aneurysm | The wall of the aorta, where it passes down through the chest, becomes weak and bulges like a balloon. This is the most common case where TEVAR is used. |
| Aortic Dissection | Blood leaks between the layers of the inner wall of the aorta, causing the wall to tear lengthwise. This is a very urgent and dangerous condition. |
| Aortic Transection | Tearing or rupture of the aorta due to severe trauma to the chest from a serious accident, such as a car accident. |
How should I prepare before this surgery?
Your doctor will explain this to you in detail . You should usually be prepared for things like:
- Medication use: If you are taking medication for high blood pressure or cholesterol, you should use it exactly as directed.
- Avoid smoking: If you smoke, you will need to stop completely before surgery.
- Other medications: Tell your doctor about any other medications you are currently taking (e.g., blood thinners). They may need to be temporarily stopped or changed, if necessary, according to his or her advice.
- Pre-surgery tests: Several tests will need to be done before the surgery.
Preoperative tests
One of the most important tests is a CT angiogram . This can produce a clear, three-dimensional image of the size, location, and health of your aorta and other blood vessels that connect to it. For TEVAR surgery to be successful, there must be enough room in your blood vessels to allow the thin tube (catheter) used for the treatment to be advanced into the aorta.
Doctors usually insert this tube through the femoral artery, which runs through the groin of the leg. But if that blood vessel is narrowed or blocked by cholesterol deposits (plaque), they have to find another route. A CT scan is essential to plan all of this.
These tests also help you choose the right size and type of stent graft for the damaged part of your aorta.
How TEVAR surgery is performed
When performing this treatment, the surgical team follows these steps:
1. Anesthesia: You will be given either general anesthesia or local anesthesia with sedation to ensure that you do not feel any pain and are comfortable throughout the surgery.
2. Spinal cord protection: In some cases (not everyone), a thin tube (lumbar drain) that removes a small amount of cerebrospinal fluid from the spinal cord may be used to prevent damage to the spinal cord from decreased blood flow during surgery.
3. Small incision: A very small incision is made in the skin in the groin area of the leg, near the femoral artery.
4. Insertion of the tube: Through this incision, a thin wire (guide wire) is passed along the blood vessel until it passes the damaged part of the aorta. Then, a thin tube called a catheter with a stent graft inside is inserted over this wire. All this is done under the guidance of a special X-ray-like technique ( fluoroscopy ).
5. Stent placement: The catheter is guided to the exact location of the damage and the stent graft inside is released. It opens like a spring and firmly attaches to the walls of the aorta.
6. Function: This stent graft now acts as a new lining for the aorta. In the case of an aneurysm, blood flows through this new lining. This takes the pressure off the weakened wall from the blood. This stops it from getting bigger and bursting.
7. Completion of the surgery: After the stent is placed, the catheter is removed, the small incision made in the groin is closed with stitches and a bandage is applied.
Usually, this entire process takes about two hours.
What are the benefits of TEVAR treatment?
These are the reasons why doctors prefer the TEVAR method over open surgery.
- The recovery time and hospital stay are very short.
- Since there is no large incision to cover the chest, there is less pain.
- There is less bleeding during surgery.
- It has similar successful outcomes to open surgery.
- The risk of serious complications or death is low (about 98% survival rate with TEVAR, compared to 88%-94% with open surgery).
- Damage from reduced blood supply to other organs (end-organ ischemia) is minimal.
Are there any risks with this treatment?
As with any surgery, there are some risks involved, but they are very rare.
- Endoleak: Blood still leaking around the stent graft into the aneurysm.
- Infection: Infection at the surgical site.
- Graft movement: The stent that was placed moves slightly from its original position.
- Paraplegia: Very rarely, loss of function in the legs due to decreased blood supply to the spinal cord.
- Heart attack or stroke.
Talk to your doctor about these risks and steps you can take to reduce them.
Recovery and follow-up
After the surgery, you will stay in the intensive care unit (ICU) for a day or two. After that, you will be transferred to a regular ward and will be able to go home within a day or a week. When you go home, take care of these things:
- Do not drive for 1-2 weeks.
- Do not get in a tub of water until the groin incision has healed (it's okay to take a shower).
- Do not lift more than 5 kg for 1-2 weeks.
The most important thing is follow-up . This is something that needs to be done for life. As the doctor says, you need to have tests like a CT scan after the surgery, one month, six months, a year, and every year after that, to see if the stent is still in place and if there are any other problems.
If you develop symptoms of a heart attack (e.g., severe chest pain) or stroke (e.g., drooping of one side of the face, difficulty speaking), go to the nearest hospital's Emergency Department (ETU) immediately.
Take-Home Message
- TEVAR is a modern treatment method for dangerous conditions such as aortic aneurysms, performed through a small incision without opening the chest.
- This is a highly successful treatment with fewer risks than open surgery, a quicker recovery, and a faster recovery time.
- Your doctor will determine whether this treatment is right for you after tests.
- It is mandatory to undergo follow-up examinations as directed by the doctor throughout life after surgery.
- If you have any concerns about your treatment or recovery process, please speak to your doctor without hesitation.
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