Thoracic Endovascular Aortic Repair in Delhi, India

Thoracic Endovascular Aortic Repair is a procedure performed to treat diseases and injuries of the thoracic aorta, the large artery that carries blood from the heart to the rest of the body. Conditions such as thoracic aortic aneurysms, aortic dissections, and traumatic aortic injuries can weaken or damage the aorta, increasing the risk of rupture or other life-threatening complications.

In TEVAR, a stent-graft (a fabric-covered metal tube) is inserted into the affected area of the aorta using a catheter, typically through a small incision in the groin. The stent-graft reinforces the aortic wall, restores normal blood flow, and reduces pressure on the weakened area. This method provides a less intrusive alternative to open surgery, with shorter recovery times and lower risk.

TEVAR is a vital procedure for addressing life-threatening conditions of the thoracic aorta. It is typically recommended for the following conditions:

Thoracic Aortic Aneurysms

Thoracic Aortic Aneurysms occur when a section of the thoracic aorta weakens and balloons outward. Aneurysms increase the risk of rupture, can cause severe internal bleeding and is often fatal without timely intervention. TEVAR is advised when the aneurysm reaches a size or growth rate deemed dangerous or is causing symptoms such as chest pain or back pain.

Aortic Dissections

A tear in the aorta's innermost layer results in an aortic dissection, allowing blood to pass between the layers of the arterial wall. This can compromise blood flow to essential organs or result in rupture. TEVAR is commonly recommended for Type B dissections (affecting the descending aorta) that lead to complications such as persistent pain, organ dysfunction, or rapid expansion.

Traumatic Aortic Injuries

Severe trauma, such as that from motor vehicle accidents or falls, can result in tears or ruptures of the thoracic aorta. TEVAR is an effective emergency treatment to stabilise the injury, repair the damaged section, and prevent catastrophic bleeding.

Penetrating Atherosclerotic Ulcers

Advanced atherosclerosis can lead to ulcers in the aortic wall, which may progress to dissections or ruptures. TEVAR is recommended to strengthen the weakened section of the aorta and reduce any risk of complications. 

Infectious or Inflammatory Aortic Diseases

Conditions such as mycotic aneurysms (caused by infection) or aortitis (inflammation of the aorta) may also require TEVAR when medical therapy alone is insufficient and the risk of rupture or progression is high.

Genetic or Congenital Conditions

Individuals with connective tissue disorders such as Marfan syndrome, Loeys-Dietz syndrome, or a bicuspid aortic valve may develop thoracic aortic abnormalities. TEVAR can be an option in such cases where surgery is needed, but open repair poses higher risks.

Initial Evaluation and Tests

Before the TEVAR procedure, a thorough evaluation is conducted to ensure the patient is fit for the procedure. This includes a review of the patient’s medical history, a physical examination, and diagnostic tests. These tests ensure that the patient is well-prepared for surgery and that any underlying health issues are identified.

Pre-Procedure Instructions

Leading up to the procedure, the healthcare team provides specific instructions. Patients might be advised to discontinue specific medications, such as blood thinners, several days prior to the procedure. This helps reduce the risk of bleeding during and after TEVAR.

Patients are typically advised to fast for at least 6-8 hours prior to the procedure. This is especially important for those undergoing general anaesthesia, as an empty stomach reduces the risk of complications.

Admission and Preparation

On the day of the procedure, or sometimes the night before, patients are admitted to the hospital. Upon arrival, a nurse will insert an intravenous (IV) line to deliver fluids and medications throughout the procedure. The anaesthesia team discusses the anaesthesia plan and ensures the patient understands what will happen.

1. Anaesthesia and Incision

TEVAR is usually carried out under general anaesthesia, keeping the patient relaxed and pain-free during the entire procedure. The anaesthesiologist will monitor the patient’s vital signs during the procedure to make sure they remain stable. A small incision is then made, usually in the groin or arm, to access the femoral or subclavian artery.

2. Stent-Graft Placement

Once access to the artery is gained, a catheter is threaded through the artery and guided to the affected area of the aorta. Using advanced imaging techniques such as fluoroscopy, the surgical team can see real-time images of the aorta, ensuring precise placement of the stent-graft.

The stent-graft, which is a tube-like structure made of metal and fabric, is deployed to reinforce the weakened section of the aorta and restore proper blood flow. This step is crucial to prevent further damage to the aorta and to support the vessel as it heals.

3. Closing The Incision

Once the stent-graft is successfully positioned, the incision is closed with sutures or a bandage, and the patient is moved to a recovery area. The minimally invasive nature of TEVAR means a shorter hospital stay and less trauma to the body compared to traditional surgery.

1. Recovery

After the procedure, patients are moved to a recovery area for close monitoring. Vital signs, including heart rate, blood pressure, and oxygen levels, are frequently checked to ensure the patient remains stable. Most patients are able to breathe on their own and regain consciousness without complications.

2. Hospital Stay

After the initial recovery, most patients stay in the hospital for 1 to 3 days. During this time, healthcare professionals monitor the patient’s condition and manage any pain. It is common to experience mild discomfort or soreness at the incision site, which can usually be managed with prescribed pain relief medications.

3. Discharge and Follow-Up

Once discharged, patients are given detailed instructions for their recovery at home. This includes refraining from strenuous activities and heavy lifting for a few weeks.

Follow-up appointments are scheduled to ensure the stent-graft remains in place and that there are no complications. Imaging tests like CT scans or MRIs are performed to confirm the success of the procedure and monitor the health of the aorta.

TEVAR offers several key benefits compared to traditional open surgery for treating thoracic aortic conditions.

• Minimally Invasive: Involves smaller incisions, reducing tissue disruption and trauma compared to open surgery.
• Shorter Recovery Time: Faster recovery, with most patients leaving the hospital within 1–3 days and returning to normal activities within weeks.
• Reduced Risk of Complications: Lower risk of infection, blood loss, and damage to surrounding tissues compared to traditional surgery.
• Precision and Accuracy: Advanced imaging techniques ensure precise placement of the stent-graft, leading to better outcomes.
• Long-Term Effectiveness: High success rates with proper follow-up care, ensuring the stent-graft remains functional over time and preventing further damage to the aorta.

Like all medical procedures, TEVAR carries certain risks and potential complications:

• Infection: There is a risk of infection at the incision sites, even though the procedure is minimally invasive.
• Bleeding: Potential for bleeding during catheter insertion or if a blood vessel is injured, which may require additional treatment.
• Endoleak: This occurs when blood leaks into the aneurysm sac despite the presence of the stent-graft, which may require additional treatment or ongoing monitoring.
• Stent-Graft Migration: The stent-graft may shift from its original position, requiring repositioning or replacement in some cases.
• Aneurysm Rupture or Dissection: There is a risk of the aneurysm rupturing or aortic dissection after the procedure if the stent-graft does not seal properly.
• Stroke: Low risk of stroke due to embolism or clot formation during the procedure, which could block blood flow to the brain.
• Kidney Damage: Potential for kidney damage from the contrast dye used during imaging studies, especially in patients with pre-existing kidney conditions.
• Paraplegia or Paralysis: A rare type of spinal cord injury that can cause paralysis if blood flow to the spinal cord is disturbed.
• Artery Injury or Dissection: Possible injury to the arteries used for accessing the aorta, which may require further surgery to address.

These risks are relatively rare and are managed through careful monitoring and follow-up care to ensure the best possible outcomes.

Is TEVAR suitable for all patients with thoracic aortic conditions?

TEVAR is not appropriate for everyone. Factors such as the location and size of the aneurysm or dissection, as well as the patient's overall condition, all influence the outcome. A comprehensive review by a specialist is required to decide whether TEVAR is the best treatment option.

How long does the TEVAR procedure take?

The TEVAR process usually takes between 2 to 4 hours, which depends on the severity of the case. The doctor will give you a more precise estimate depending on the particular condition. 

Are there any lifestyle changes I need to make after TEVAR?

Most patients are able to return to their normal lifestyle within a few weeks. However, it is critical to follow your doctor's post-operative care instructions, such as taking medications as prescribed, attending follow-up appointments, and avoiding heavy activity at first. 

How soon will I notice improvement after the procedure?

You may start feeling better soon after the procedure, particularly in terms of reduced pain or discomfort. Full recovery takes time, and regular follow-up appointments are important to monitor the repair and your overall health.

What are the chances of a repeat procedure after TEVAR?

Although TEVAR is highly effective, there is a small risk that additional treatment may be required over time if complications like endoleaks or stent migration occur. Regular monitoring helps identify these issues early.

Can TEVAR be performed if I have other health problems, like diabetes or high blood pressure?

Yes, many patients with conditions like diabetes or high blood pressure undergo TEVAR successfully. However, these conditions must be well managed before the procedure. The doctor will evaluate your overall health to decide the most appropriate treatment plan.

Reviewed by Dr. Viveka Kumar, Vice Chairman & Chief of Cath Labs (Pan Max) - Cardiac Sciences, Cardiology, Interventional Cardiology, Cardiac Electrophysiology-Pacemaker, on 09-June-2025.