Introduction:
Thoracic aortic aneurysm surgery is an approach to treat a bulge (aneurysm) weak spot in the thoracic aorta, which creates turbulence. An aorta is an extensive artery that maintains blood flow from the heart through the chest and other body parts. In contrast, the thoracic aorta is the portion of the aorta in the chest that starts at the heart (cardiac) and extends via the chest and abdomen wall before it ends at the pelvis.
What Are the Investigations to Rule Out the Thoracic Aorta Aneurysm?
Imaging tests that can confirm or screen for a thoracic aortic aneurysm are as follows:
-
Echocardiogram: This method utilizes sound waves to reveal blood flow through the cardiac chamber and blood vessels, including the aorta. A transesophageal echocardiogram gives a better view. A flexible tube with an ultrasound rod is navigated down the throat and into the tube joining the mouth to the stomach (esophagus).
-
Computerized Tomography (CT): It uses X-rays to construct cross-sectional images of the body, including the aorta. It can catch the size and shape of an aneurysm. During a CT scan, an individual generally lies on a table inside a doughnut-shaped X-ray machine. A contrast medium (dye) may be delivered intravenously to allow the arteries to be displayed more evidently on the X-ray.
-
Magnetic Resonance Imaging (MRI): A cardiac MRI utilizes magnetic fields and radio waves to construct precise images of the heart and aorta and their size and location. In this test, intravenous dye (contrast) is introduced into the blood vessels and appears more clearly in the images. This procedure is similar to computerized tomography but reduces radiation exposure.
What Are the Surgical Modalities Available for Thoracic Aortic Aneurysm?
1. Open-Chest Surgery: This procedure involves removing a portion of the aorta harmed by the aneurysm. Then, the aorta section is replaced with a synthetic tube (graft) stitched into place. A full recovery takes a month or more.
2. Aortic Root Surgery: This open-chest surgery treats an enlarged area of the aorta to preclude the rupture of the aneurysm. Aortic aneurysms close to the aortic root may be linked to Marfan syndrome (a disorder of connective tissue that affects the heart, eye, blood vessels, and bone) and other related conditions. The operation involves the removal of part of the aorta, and in some cases, the aortic valve, where a graft substitutes the removed area of the aorta to achieve physiology. In the case of aortic valve involvement, the valve may be substituted with a mechanical or biological valve. The surgery is named valve-sparing aortic root rehabilitation in case the valve is not removed.
3. Thoracic Endovascular Aortic Aneurysm Repair (TEVAR): This approach is a minimally invasive procedure with a small incision with great outcomes, which involves the insertion of a thin, adaptable tube called a catheter into a blood vessel, usually in the groin region, and directed towards the aorta. A graft with a metal mesh tube covered by fibers usually affixed to the end of the catheter is positioned at the aneurysm site. This graft strengthens the weakened section of the aorta to prevent rupture of the aneurysm. It is secured by small hooks or pins that hold it in place. Thus the procedure may permit a faster recovery. Some of the potential complications of this approach are:
-
Infection.
-
Bleeding.
-
Injury to adjacent organs or tissue.
-
Blood clots or embolism or thrombosis.
-
Anesthesia risks.
-
Device or delivery failure.
-
Blood vessel damage.
-
Dripping graft.
-
Paralysis or loss of the foot or leg.
-
Displacement of the graft.
-
Traditional open surgery may be needed in some cases.
-
Recurrence of aortic aneurysm after surgery.
A ruptured thoracic aortic aneurysm demands emergency open-chest surgery. However, this surgery is dangerous and has high odds of complications. Therefore, it is important to diagnose and treat thoracic aortic aneurysms before their rupture with preventive surgery and frequent monitoring.
What Are the Types of Thoracic Aorta Dissections?
DeBakey Classification: This divides the dissections into the following types:
- Type I: The dissection implicates in aortic arch, ascending aorta, descending aorta, and abdominal aorta.
-
Type II: The dissection entangles ascending aorta but blocks at the aortic arch level and does not involve the aorta beyond the left subclavian artery.
- Type III: The dissection starts distal to the left subclavian artery and expands to the entire descending thoracic and abdominal aorta.
Stanford Classification: This has become widespread, especially because of its therapeutic implications.
- Type A Aortic Dissection: Involves ascending aorta and often advances into the arch, descending thoracic, and abdominal aorta.
- Type B Aortic Dissection: Dissection begins above the aortic arch, usually at the subclavian artery, and advances distally but does not involve ascending aorta or the arch of the aorta.
Based on the Timing of the Presentation:
- Acute Aortic Dissection: The patient presents within two weeks from the onset of pain.
- Subacute Aortic Dissection: The patient presents between two to six weeks after the onset of pain.
- Chronic Aortic Dissection: The patient presents six weeks after the onset of pain.
What Happens During Thoracic Aortic Aneurysm Surgery?
In open thoracic aortic aneurysm surgery, the surgeon:
-
Creates a large incision along the side of your chest.
-
Uses unique tools to control blood flow in the aorta temporarily.
-
Substitutes the impaired area of the aorta with an artificial graft.
-
Seals the incision with sutures and stitches.
While during thoracic endovascular aortic aneurysm repair (TEVAR), the surgeon:
-
Inserts a catheter and fine wires via an artery in the groin area.
-
Direct the catheter to the thoracic aorta.
-
Infiltrates a contrast dye via the catheter to visualize the thoracic aorta.
-
Utilizes CT or X-ray direction to position the stent graft accurately.
-
Releases the catheter and wires and positions a bandage over the incision area in the groin.
What Occurs Following Treatment For A Thoracic Aortic Aneurysm?
After open surgery, patients are sent to the intensive care unit (ICU) for quick recovery and be transferred to another section of the hospital after a day or two, where one has to stay for up to 10 days. After TEVAR surgery, they typically stay in the hospital for three days. Patients might experience minor discomfort and bruising. The doctor will give patients medicine to control pain.
Conclusion
An aneurysm is the bulging within the aortic wall that makes the arteries weak and susceptible to rupture due to the blood flow's turbulence. The thoracic aortic aneurysm repair surgical intervention requires great skills to have good outcomes. Thus, the cardiologists and the surgeon team exclude the operation in a better and more secure way with the least postoperative complications.
