Promising New Procedure Gives Thoracic Aortic Aneurysm Patients Renewed Hope for Repair and Recovery

July 9, 2010

5 star surgical careFloyd Memorial has recently become the only hospital in Southern Indiana to offer a procedure called Thoracic Endovascular Aneurysm Repair (TEVAR). In addition, Floyd Memorial is the only hospital in the entire metropolitan Louisville region to offer the procedure with the expertise of a cardiovascular and thoracic surgeon working in tandem with an interventional radiologist, a unique approach that combines the talents of each specialist to ensure the best possible outcome for patients.

What is a Thoracic Aortic Aneurysm?

The aorta is the largest artery in the body, carrying blood away from the heart to all parts of the body. The portion of the aorta that runs through the chest cavity nearest the heart is called the thoracic aorta, while the portion running through the abdomen is known as the abdominal aorta. When a weakened area of the thoracic or abdominal aorta expands or bulges, it is known as a thoracic aortic aneurysm (TAA) or abdominal aortic aneurysm (AAA). Roughly 25 percent of aortic aneurysms occur in the thoracic aorta, while 75 percent occur in the abdominal aorta.

Approximately 15,000 people in the United States suffer a TAA each year. They are very serious and life threatening, with only 20 to 30 percent of patients who make it to the hospital with a ruptured TAA surviving. For this reason, it’s critical to detect and treat large aneurysms early, in order to prevent a deadly rupture.

Seyhan Senler, MD
“The Thoracic Endovascular Aneurysm Repair (TEVAR) procedure is revolutionary because it gives patients a minimally invasive repair option that has proven to be better tolerated and offers lower risk than the traditional open repair, while also boasting superior long-term results. TEVAR patients can return home after three to four days in the hospital, whereas open repair patients remain hospitalized for one to two weeks, sometimes longer. And, TEVAR patients can return to normal activities within a week, while open repair patients typically undergo a three to four month recovery process. It’s an innovative procedure that has truly risen the standard of care and survival rates for thoracic aortic aneurysm patients.”

Seyhan Senler, MD
Board Certified Interventional Radiologist
Radiology Associates, Inc.

Early Detection and Repair is Key

Seyhan Senler, MD, a senior interventional radiologist for Radiology Associates, Inc., explained why early intervention is so important. “Since survival rates for ruptured TAA’s are so low, it is critical that the condition be detected and repaired as early as possible so that ballooning and rupture of the aneurysm can be avoided. Couple this with the fact that most patients are asymptomatic, and that there is no standardized screening test for diagnosis, and you can see why this is such a serious condition.”

Symptoms and Risk Factors of Thoracic Aortic Aneurysm Can be Challenging to Identify

One reason TAA has such a high mortality rate is because symptoms can be hard to identify or absent altogether, preventing patients from seeking care until the aneurysm is extremely large or ruptured. Only about 50 percent of patients report noticing any symptoms, but if symptoms are experienced, they will depend on the size and location of the aneurysm.

Possible symptoms include:

  • Chest pain, back pain or pain between the shoulder blades
  • Pain in the jaw, neck and upper back
  • Coughing, hoarseness or difficulty breathing

While we do not know exactly what triggers aneurysms to develop, we do know that they result from weakening of the aortic wall, which then causes a “ballooning” of the aorta in the location of the aneurysm.

Factors that could contribute to deteriorationof the aortic wall include:

  • Increasing age
  • High blood pressure
  • High cholesterol
  • Smoking
  • Diabetes
  • Family history of aneurysms

“That said, we do have several different diagnostic modalities that can potentially detect a TAA,” added Dr. Senler. “Depending on the size and location of the aneurysm, a chest X-ray or CT, and sometimes even an abdominal CT can all help us in identifying a TAA. Each case is different; we may see it on one modality, but not on another.”

Options for Repair

Before TEVAR, patients had limited treatment options available for TAA. Dr. Senler explained, “Up until recently, TAA patients’ only options were “watchful waiting” for small aneurysms, which simply involves regular monitoring of the size and shape of the aneurysm, and open surgical repair for larger aneurysms at active risk of rupture.”

Franco Rea, MD, a board certified cardiovascular and thoracic surgeon, described the traditional open procedure, “Open surgical repair is a very serious operation. It involves placing the patient on a by-pass machine and completely opening up the chest and abdominal cavity to access and repair the aneurysm by reinforcing the weakened portion of the aorta with a fabric coated stent known as a stent graft. The graft allows blood to flow through it without risk of rupture. Hospital stays range from one to two weeks, and recovery is typically three to four months before the patient can return to normal activity.”

Dr. Rea continued, “It’s important to keep in mind that most TAA patients are advanced in age and typically have multiple co-morbidities such as diabetes, heart disease, etc. Many times the patient’s co-morbidities kept them from being a candidate for the open repair because it was just too risky. This is one of the many reasons why we’re so excited that we can now offer patients a minimally invasive procedure with much lower risk.”

When a weakened area of the thoracic aorta expands or bulges, it is known as a thoracic aortic aneurysm (TAA).

Surgeons repair the aneurysm by reinforcing the weakened portion of the aorta with a fabric coated stent known as a stent graft. The graft allows blood to flow through it without risk of rupturing the aneurysm.

TEVAR-How it Works to Repair Thoracic Aortic Aneurysms

According to Dr. Senler, “Thoracic Endovascular Aneurysm Repair is a progression of the stent grafting technology that we’ve been using for several years to repair abdominal aortic aneurysms (AAA). It involves making a small incision in the common femoral artery in the groin and threading a catheter that contains a stent graft up through the artery until it reaches the location of the aneurysm. We are able to utilize live imaging to guide the graft to the proper location, and then put it in place to allow blood to flow through the aorta without putting pressure on the weakened wall where the aneurysm is located. The result is exactly the same as in open repair, but with only one small incision in the groin, the risk is much lower and recovery is faster and less painful.”

Franco Rea, MD
“Numbers speak for themselves, and the data we have on TEVAR versus open repair of thoracic aortic aneurysm is staggering. The average mortality rate for open repair is 20 percent, and the average morbidity rate, which means the rate at which patients suffer complications such as stroke, pneumonia, etc., is 40 to 50 percent. Compare these rates to those for TEVAR repair, which are five percent mortality and five to 10 percent morbidity, and you can see why we’re so excited to offer this to our patients.”

Franco Rea, MD
Board Certified Cardiovascular & Thoracic Surgeon
Kentuckiana Thoracic & Vascular Surgery

Dr. Rea elaborated, “After performing more than 125 successful procedures together, Dr. Senler and I felt comfortable enough with the procedure and with the synergy we’ve developed working together in the operating room to begin offering TEVAR to our thoracic aneurysm patients. We’re confident that patients who are candidates for this procedure will have an excellent result.”