Thoracic Aortic Aneurysm Repair

How UVA's Surgeons Repair Thoracic Aortic Aneurysms

Our surgeons repair many thoracic aortic aneurysms with covered aortic stents (stent-grafts) inserted into the aorta through an artery in the groin. The stent is placed inside the aneurysm, preventing blood from flowing into the aneurysm.

Over time, the aneurysm shrinks. In some patients, when stents are not possible, open surgery (requiring an incision in your chest) may be necessary to repair the aneurysm by placing an artificial blood vessel into the aorta to replace the aneurysm.

Symptoms of a Thoracic Aortic Aneurysm

Most thoracic aortic aneurysms develop slowly over time and can remain remarkably asymptomatic until they actually leak, tear or rupture, which is often an emergency.

As a result, most thoracic aortic aneurysms are diagnosed incidentally when someone undergoes a CT scan for some other reason. Thoracic aneurysms can sometimes be detected on a plain chest X-ray or when someone undergoes an ultrasound examination of their heart.

When a thoracic aneurysm ruptures, the patient will often experience excruciating chest or back pain and may have difficulty breathing and may lose consciousness. Sometimes patients will notice an unusual back pain that they have never felt before, prior to the aneurysm actually leaking. Rarely, some aneurysms grow large enough to put pressure on certain nerves, or the airway or food pipe (esophagus), and cause symptoms such as hoarseness, wheezing or difficulty swallowing.

How a Thoracic Aortic Aneurysm is Treated

A leaking thoracic aneurysm is an emergency and requires immediate treatment with either surgery or placement of a special type of covered aortic stent (stent-graft).

The location of the aneurysm partly determines whether or not a stent-graft can be used to treat the aneurysm. It is important to treat aneurysms before they rupture, because once a thoracic aneurysm ruptures chances of survival fall to 50%. However, when patients are treated before the aneurysm ruptures, chances of survival are greater than 90%.

During traditional “open” surgery, the aneurysm is opened and an artificial blood vessel or “graft” is sewn in its place. The aneurysm itself is not necessarily removed. However, our preferred way to treat thoracic aortic aneurysms is with stent-grafts, which can be done without major chest surgery in some patients.

Open Aortic Aneurysm Repair

An open aortic aneurysm repair is an effective, long-lasting treatment option for aneurysms in your aorta. But it comes with risks. W. Darrin Clouse, MD, explains how UVA’s Aortic Center is best equipped for procedures like open aortic aneurysm repair.

What is an Aortic Dissection and How is it Treated?

An aortic dissection is a tear in the layers of the aorta. An aorta has several layers, much like an onion. Blood enters between these layers causing a tear that can multiply along the length of the aorta. This can lead to rupture, or inadequate blood flow to the brain, intestines, kidneys or legs.

Dissections can occur in patients with aneurysms. Dissections, when located in the descending aorta can often be treated with aortic stents, similar to thoracic aortic aneurysms, with the primary goal to cover the point of tear and eliminate blood flow in the torn aorta.

About Stent-Grafts

Aortic stent-grafts are large-diameter stents (metal scaffolds) covered with impermeable materials that are used to “re-line” the inside of the aorta.

In essence, aortic stent-grafts provide a new lining to the aorta and can therefore be used to take the pressure off of an aneurysm and keep it from getting bigger, or can be used to “push” the layers of the aorta back together in patients with an aortic dissection.

Stent-grafts to treat thoracic aortic aneurysms have been available for about 10 years and are now an FDA-approved therapy. Stents are available at select centers for use in aortic dissections. At UVA, we are involved in several clinical trials that allow the use of these stents to treat descending thoracic dissections.

Stent-Grafts at UVA

Cardiovascular surgeons at UVA have been using stent-grafts to treat thoracic aortic aneurysms, dissections and other thoracic aortic problems for the past 10 years and have been part of the first major national clinical trials evaluating the effectiveness of thoracic aortic stent-grafts to treat these problems. Stent-grafts are significantly less invasive than standard open surgery, but are not yet an option for everyone with a thoracic aortic aneurysm or dissection.

Why Choose UVA for Treatment of Your Thoracic Aortic Aneurysm?

UVA's cardiovascular surgeons are specially trained in both cardiac and vascular surgery in order to enable them to most effectively treat thoracic aortic aneurysms.

In addition, UVA has served as a regional referral center for patients with thoracic aortic aneurysms for decades. As a result, a multidisciplinary team is available 24 hours day with the latest diagnostic tools, CT scans, intensive care and operating room availability to diagnose and treat patients within minutes of arrival in our emergency room.

UVA was the first medical center in Virginia to use stent-graft technology to treat thoracic aortic aneurysms nearly a decade ago. We continue to be involved in the latest clinical trials evaluating new and improved stent-grafts for the treatment of thoracic aortic and aneurysms.