Thoracic Endovascular Aneurysm Repair (TEVAR)

Overview

Thoracic Endovascular Aneurysm Repair (TEVAR) is a recently developed treatment for patients with distal arch, descending or thoraco-abdominal aneurysms. Cedars-Sinai now offers this new approach and since late 2005, Cedars-Sinai surgeons have successfully repaired complex thoracic aortic aneurysms in high-risk patients using a minimally invasive catheter approach. X-ray and ultrasound are used by surgeons and radiologists to guide the delivery of a graft-covered stent within the aneurysm, through a small incision in the groin.

TEVAR is performed using a comprehensive team approach using the experienced thoracic aortic surgery and interventional radiology teams at Cedars-Sinai. Physicians and team members involved include cardiothoracic surgeons, interventional radiologists, anesthesiologists, thoracic aortic nurse practitioner, cardiothoracic physician assistants, liaison nurses, and interventional technicians.

For additional information about the TEVAR procedure, please contact the Thoracic Aortic Surgery Program.

During typical open-heart surgery, blood continues to circulate throughout the body, although major blood vessels are clamped to prevent the flow of blood into the surgical area. However, in aortic surgery it is necessary to perform procedures without clamping the aorta, while at the same time keeping the surgical field free of blood. The dilemma facing aortic surgeons was how to temporarily stop blood circulation without causing neurological injury to the patient. An effective solution was found in hypothermic circulatory arrest (HCA), also called total circulatory arrest (TCA). HCA was first used in the late 1970s in conjunction with aortic arch surgery. In the mid-1980s it was applied to surgery of the ascending aorta, and since 1994 it has also been used in descending and thoracoabdominal aortic surgery at Cedars-Sinai.

Hypothermic circulatory arrest is the temporary suspension of blood flow under very cold body temperatures. At these cold temperatures cellular activity levels slow significantly, and blood circulation can be stopped for up to 40 minutes without harm to the patient. This allows surgery to safely be performed on the aorta when clamping to contain blood flow is either not possible or not desirable.

The open anastomosis technique for ascending aortic surgery, used in conjunction with HCA, clearly illustrates the significance of this approach. This technique has proven to be so important to the long-term results in surgery of the ascending aorta that it is now the standard of care for this surgery. With the open anastomosis technique the ascending aorta is not clamped while the aneurysm is resected and the Dacron graft sewn to the aortic arch, thus avoiding any damage a clamp might cause to the remaining aortic tissue. This same technique also applies when the surgery extends into the aortic arch. The ability to safely perform this procedure is due to the use of HCA during the time the aorta is open and unclamped.