Have you heard of the largest and most important blood vessel in your body, the aorta? Think of it like the main water pipe that brings water to our house. When the heart pumps clean blood, that blood is distributed throughout the body through this aorta. So, when a place in the wall of this most important blood vessel becomes weak and bulges out like a bubble in an old tire, we call it an 'aneurysm' in medicine. If this bulge occurs in the part of the aorta that runs through the chest, we call it a 'Thoracic Aortic Aneurysm'. Although this name is a bit scary, let's talk about it clearly and simply.
What is a thoracic aortic aneurysm?
Simply put, the aorta is the main blood vessel in our body that starts at your heart, goes through your chest and abdomen, and ends near your pelvis. If there is a weakness in one of its walls, the pressure from the blood flowing through it causes that weak spot to bulge like a balloon. This is what we call an aneurysm.
This condition is not that common. According to statistics, it affects about one in ten thousand people. So don't panic when you hear this name.
Who needs surgery for this condition?
Not everyone with this type of swelling will need surgery. Your doctor will consider several factors to decide whether you need surgery or not.
- Size of the aneurysm: This is the most important factor. Generally, if the aneurysm is larger than 5.5 centimeters , or if it is growing more rapidly than 0.5 centimeters within six months , your doctor may consider surgery.
- Your symptoms: Sometimes this swelling can cause symptoms like chest pain and difficulty breathing. If this happens, surgery may be recommended, even if the size is small.
- Your overall health: Your age and whether you have other medical conditions (e.g. diabetes, heart disease) also affect this decision.
The most important thing is that this decision is made by your doctor. So, don't hesitate to discuss any questions or concerns you may have with your doctor.
What types of surgeries are available for this?
There are two main types of surgery to treat this condition. Let's clearly understand the difference between the two.
| Type of surgery | The way to do it is simple. |
|---|---|
| Open Thoracic Aneurysm Repair | This is a traditional surgical procedure. The surgeon makes a long incision in the side of your chest and reaches the damaged part of your aorta. Then, the swollen, weakened part is removed and replaced with a synthetic graft. This is a major operation. |
| Endovascular surgery (TEVAR) | This is a modern, minimally invasive procedure. Your chest is not punctured. Instead, your doctor inserts a very thin tube (catheter) through a blood vessel in your groin. Through this tube, a special mesh-like device (stent graft) is passed into the swollen area and stretched from the inside. The blood then flows through the new tube. There is no pressure on the swollen wall. |
The medical team will determine which surgery is best for you based on the location and size of your bulge, and your health condition.
Why is this surgery so important?
The main reason for performing this surgery is to prevent the rupture of the aneurysm that has formed in the aorta.
Imagine, this balloon-like swelling could burst one day due to the high blood pressure inside. If that happens, there will be a massive hemorrhage into the body, which is a very serious and immediate threat to life. Therefore, if the doctors think that the risk of this swelling bursting is much greater than the risk of surgery, they recommend this surgery. In other words, this is a precautionary measure to prevent it before it becomes a major accident.
What happens before the surgery?
Once you have decided to have surgery, there are several steps you can take to prepare for it.
- Scans: The doctor will use special scans, such as a CT scan, to further examine the size and condition of your swelling.
- Medications: You may be given certain medications a few days before surgery to control your blood pressure and relax your blood vessels.
- Medications that prevent blood clotting: If you are taking blood-thinning medications (anticoagulants), your doctor will advise you to stop taking them a few days before the surgery.
Your medical team will give you clear instructions about all of this.
What happens during the surgery?
What happens in the two types of surgeries is slightly different.
How to perform open surgery
- The surgeon makes a long incision on the side of the chest.
- Using special equipment, blood flow to the part of the artery being operated on is temporarily stopped.
- Then, the damaged, swollen part is cut out and removed, and a graft is implanted in its place to restore blood flow.
- Finally, the incision is closed with stitches.
How TEVAR surgery is performed
- The doctor inserts a thin tube (catheter) and wires through a blood vessel in your groin.
- This tube is guided to the location of the aneurysm in the chest using X-ray-like technology.
- To see the blood vessels clearly, a special liquid (contrast dye) is injected.
- Then, looking at the exact spot, the stent is extended.
- When the work is finished, the tube and wire are taken out and a small bandage is placed over the insertion site in the groin.
What happens after the surgery?
The recovery time after surgery varies depending on the type of surgery.
- After open surgery: You will be admitted directly to the intensive care unit (ICU) . You will stay there for a day or two. Then you will be transferred to a general ward and may have to stay in the hospital for about 10 days.
- After TEVAR surgery: The hospital stay is usually short, about three days. There may be some bruising and pain in the groin. The doctor will give you the necessary painkillers.
The time it takes to return to normal life varies. It can take two to three months to fully recover from open surgery. It is best to avoid heavy lifting for the first 4-6 weeks. Although you can return to normal activities about two weeks after TEVAR surgery, it is best to avoid strenuous activities for about four weeks.
What are the risks of this surgery?
Although this is a life-saving surgery, like any major surgery, there are some risks involved.
But remember one thing: Doctors only recommend this surgery when the risk of death from not having surgery is much greater than the risk of surgery.
Some of the possible complications are:
- Heavy bleeding
- Impaired blood supply to the spine
- Heart attack
- Infectious conditions
- Impaired kidney function
- Respiratory problems such as pneumonia
- A stroke-like condition
- Weakness in the legs
Both of these surgeries are highly successful treatments. Especially in the case of TEVAR surgery, the success rate of stent implantation is as high as 99%.
When do I need to see the doctor after the surgery?
After you go home, you should notify your doctor immediately if you develop any signs of infection or complications. Be especially aware of the following symptoms.
| Feature to pay attention to | Description |
|---|---|
| Fever | If the body temperature is 100.4 Fahrenheit (100.4°F) or higher. |
| Changes in the incision site | Excessive redness, swelling, or blistering around the incision. |
| Constant pain | Severe pain that does not subside despite taking painkillers. |
| Swelling | Unusual swelling in the surgical area or legs. |
If you have any of these signs, do not ignore them and seek medical advice immediately.
Take-Home Message
- A thoracic aortic aneurysm is a balloon-like bulge caused by a weakening of the body's main blood vessel.
- The main goal of this surgery is to prevent the life-threatening consequences of the rupture.
- There are two main treatment methods: open surgery and minimally invasive TEVAR surgery.
- The medical team will decide which surgery is best for you.
- Recovery time after surgery varies depending on the type of surgery, and it is very important to follow medical instructions carefully.
- If you experience any unusual symptoms after surgery, notify your doctor immediately.
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