Thoracic endovascular aortic repair (TEVAR)

Thoracic endovascular aortic repair (TEVAR) is a less invasive way to fix problems in the upper part of the aorta, the large artery that carries blood from the heart. Doctors place a small tube called a stent graft inside the aorta to support the artery and improve blood flow. TEVAR is often used to treat issues like bulges, called aneurysms, or tears in the aorta, helping prevent serious complications. This procedure usually leads to a faster recovery compared to traditional open surgery.

Penn Medicine surgeons have been at the forefront of TEVAR since its introduction, leading the way in developing and using innovative devices to treat complex aortic diseases with minimally invasive techniques.

A TEVAR procedure is typically recommended for individuals with conditions affecting the thoracic (upper) part of the aorta, such as:

• Thoracic aortic aneurysm: A bulge or weakening in the wall of the aorta that risks rupturing
• Aortic dissection: A tear in the inner layer of the aorta that can cause blood to leak between the layers of the artery wall
• Traumatic aortic injury: Damage to the aorta caused by an accident or trauma

Before your TEVAR procedure, your doctor will explain how it’s done and give you time to ask questions. In preparation for the procedure, your doctor will review your medications with you and discuss your health history.

During a TEVAR procedure, you can expect:

• You’ll be under general anesthesia, meaning you’ll be asleep and pain-free throughout the procedure.
• Your doctor will make a small incision, usually in your groin area, to access a large artery. A thin tube called a catheter is inserted through this incision and guided to the damaged area of the aorta using x-ray imaging.
• Through the catheter, a metal mesh tube covered with fabric called a stent graft is delivered to the site of the aneurysm or dissection in the aorta. The stent graft is expanded to reinforce the weakened aorta, preventing further damage, and promoting better blood flow.
• Once the stent graft is in place and blood flow is redirected, the catheter is removed, and the incision is closed.

Branched endografts are specialized stent grafts used in complex aortic repairs, particularly when aneurysms involve branches of the aorta that supply blood to vital organs like the kidneys or intestines. These devices have multiple branches to maintain blood flow to those organs while repairing the aorta. They’re commonly used in thoracic and abdominal aortic aneurysms, providing a minimally invasive alternative to open surgery for complex cases.

Your surgeon will use the same TEVAR approach to guide a graft to the affected area of your aorta. Once in place, the graft is expanded so that its branches align with the natural branches of the aorta, ensuring proper blood flow to those areas.

After the procedure, you’ll be moved to a recovery area. Most patients stay in the hospital for a few days for monitoring. You’ll need a few weeks to fully recover, and it’s important to follow your doctor’s guidance on how much activity you can do and how to care for your incision.

While TEVAR is a minimally invasive procedure, your provider may recommend cardiac rehabilitation delivered by a team of specialists. These outpatient rehabilitation services focus on exercise, nutrition, education, and support during your recovery.

While the risks of TEVAR surgery are low, potential complications can include bleeding, infection, blood clots, or graft placement issues. Your doctor will review these risks with you to confirm that TEVAR is the best option for your condition.

It’s important to communicate any concerns or unexpected side effects with your provider. Your care team is highly experienced and will do everything possible to ensure you receive the best care during and after your procedure.

At Penn Medicine’s Aorta Center, patients have access to advanced endovascular devices and innovative techniques that aren’t available elsewhere, thanks to our active involvement in clinical trials. Our patient-centered approach prioritizes your well-being, providing customized treatment plans, compassionate support, and thorough follow-up care to promote recovery. In addition, our state-of-the-art facilities are equipped with the latest technology, ensuring safety and comfort throughout the diagnostic and treatment process.