Descending Thoracic Aneurysms
Descending thoracic aneurysms are aneurysms that occur above the diaphragm, and may include the aortic arch.
The most common causes of thoracic aneurysms are idiopathic cystic medial degeneration, atherosclerosis (hardening of the arteries), and genetic diseases such as Marfan syndrome.
Repair of descending thoracic aneurysms may be done through open surgery, with endovascular stent grafts, or with a combination of both procedures. Advances in surgical technique have resulted in increased use of stent grafts in the last 5 years. At the Columbia Aortic Center, surgeons now perform endovascular repair through the femoral artery, which has been shown to improve patient outcomes. When done as an elective procedure, this surgery has excellent results: 1% early mortality, 1% spinal dysfunction, and 3% incidence of stroke. These outcomes are comparable to those achieved with open (elective) surgery, with the advantage of a shorter hospital stay and a quicker return to function. Long-term results are currently under investigation nationwide.
Treating Complex Arch and Thoracoabdominal Aneurysms with Stents
Until recently, operations on the aortic arch required two operations, performed six weeks apart. With the advent of endovascular techniques, the two procedures can be combined into a single operation. The new hybrid procedure, which combines an open procedure with endovascular repair, significantly shortens the length of aortic arch surgery and reduces the adverse effects associated with these operations. The procedure takes place in our new, state-of-the-art hybrid operating room. This room is featured in our recently opened heart hospital, which is attached to the main hospital.
VIDEO: TOTAL ARCH REPLACEMENT
The availability of new fenestrated grafts provides less invasive options for patients with aneurysms located close to the kidneys, which would otherwise require open surgery. For all patients, and especially elderly patients who might be ineligible for surgery, endograft repair may provide a far safer and less traumatic alternative to open surgery. These catheter-based procedures are usually performed under local anesthesia by a multidisciplinary team including vascular surgeons, interventional cardiologists, and cardiac surgeons. Potential benefits of the procedure include less risk, shorter hospital stay, and more rapid recovery, compared to open-heart aneurysm repair.
In this minimally invasive procedure, a stent graft (comprised of a layer of impermeable reinforcement material enclosed by a self-expanding metal support mesh) is placed at the aneurysm site. To implant the stent graft, the physician inserts a catheter through the femoral artery in the groin. The stent graft is then delivered through the catheter in a collapsed state and deployed at the site of the aneurysm. The device replaces and reinforces the diseased aortic wall, ensuring continuity of blood flow. The benefits of the procedure include greatly reduced risk, a shorter hospital stay, and a more rapid recovery.
VIDEO: Endovascular Stent Graft Aneurysm Repair
View an animation of insertion of the GORE TAG® Thoracic Endoprosthesis Treatment Option for a Thoracic Aortic Aneurysm.