Thoracic Endovascular Aortic Repair (TEVAR)

Thoracic Endovascular Aortic Repair (TEVAR) is a minimally invasive surgical procedure designed to treat problems in the upper (thoracic) portion of the aorta, the body’s largest artery. Instead of open-chest surgery, TEVAR uses a small incision to guide a stent-graft (a fabric tube supported by metal mesh) into the weakened section of the aorta, helping reinforce the artery wall and prevent life-threatening complications such as rupture.

When is TEVAR performed?

TEVAR is commonly used to treat:

  • Thoracic Aortic Aneurysms: Bulging or weakening of the aortic wall.
  • Aortic Dissections: A tear in the aortic wall causing blood to flow between layers.
  • Traumatic Aortic Injuries: From accidents or falls.
  • Penetrating Aortic Ulcers: Erosion of the aortic wall due to plaque buildup.
  • Infectious or Inflammatory Aortic Diseases: Such as mycotic aneurysms.

Understanding TEVAR

Who Is a Candidate for TEVAR?

You may be considered for TEVAR if:

  • You have a diagnosed thoracic aortic aneurysm, dissection, or injury.
  • Your aortic condition is accessible via endovascular techniques.
  • You are at high risk for open-chest surgery due to age, previous surgeries, or other medical conditions.
  • You have sufficient healthy arteries above and below the aneurysm to anchor the stent-graft.
  • Your overall health allows for anesthesia and recovery from a minimally invasive procedure.
  • Evaluation by a multidisciplinary cardiovascular team is essential to determine candidacy.

How to Prepare for TEVAR

Your healthcare team will guide you through the necessary steps to get ready for TEVAR. These may include:

  • Taking medications as advised to control blood pressure and cholesterol.
  • Quitting smoking and avoiding tobacco products.
  • Adjusting your usual medication routine if required.
  • Completing pre-procedure evaluations and diagnostic tests.

Pre-Procedure Evaluation

Before TEVAR, your doctor will likely recommend imaging tests to help plan the procedure. One commonly used test is a CT angiogram. This scan provides detailed images of your arteries, showing their size and condition, which helps determine if they can accommodate the catheter and stent graft.

TEVAR involves guiding a catheter through arteries such as the femoral artery in your thigh or the iliac artery in your pelvis to reach the aorta. If these arteries are too narrow or blocked—often due to plaque buildup—your care team will explore alternate access routes.

The imaging also assists in selecting the right size and type of stent graft, ensuring it fits properly and functions as intended. For aortic dissections or injuries, the stent graft helps seal the tear. In the case of an aneurysm, it helps isolate the enlarged section of the artery, reducing the risk of rupture or further growth.

Choosing the Right Stent Graft

Selecting the appropriate stent graft is crucial to the success of TEVAR. Your healthcare provider will choose the device based on your specific anatomy and condition. For more complex aneurysms, a fenestrated stent graft may be necessary. These specialized stents have openings that allow blood flow to continue into important arteries branching from the aorta.

Fenestrated stent grafts may be used for:

  • Aneurysms affecting the aortic arch (the curved top section of the aorta).
  • Thoracoabdominal aneurysms that stretch from the chest into the abdomen.
  • Aneurysms involving critical branch arteries supplying the brain, intestines, or arms.

Your provider will explain which type of stent graft is most suitable for your condition and the reasons behind that choice.

What Happens During the Procedure?

During TEVAR, your surgical team will follow a carefully planned process to ensure both safety and effectiveness. The steps typically include:

  • Administering either general anesthesia or local anesthesia with sedation to keep you relaxed and pain-free throughout the procedure.
  • Taking specific precautions to protect your spinal cord, as TEVAR can occasionally impact spinal blood flow. One technique involves placing a lumbar drain—a thin tube used to temporarily remove cerebrospinal fluid to reduce spinal pressure. Your medical team will decide if this or other measures are necessary based on your individual situation.
  • Making a small incision near the femoral artery in your groin to access your blood vessels.
  • Inserting a guide wire through your arteries, positioning it beyond the area of concern in the aorta.
  • Using fluoroscopy (a continuous X-ray imaging technique) to guide a catheter over the wire. This catheter carries the stent graft and helps navigate it safely through your arteries.
  • Positioning the stent graft precisely over the damaged section of the aorta.
  • Removing the catheter once the stent graft is in place. The graft automatically expands to fit snugly against the inner walls of your aorta, creating a reinforced channel that diverts blood away from the weakened or injured area.
  • Closing the incision site with sutures and applying a bandage.

Hybrid Treatment Options

In certain cases—such as when an aneurysm involves a large or complex section of the aorta—doctors may combine endovascular techniques with open surgical methods. This hybrid approach allows for tailored treatment based on the location and severity of the aneurysm. Your healthcare provider will discuss whether this option is appropriate for your specific condition.

After the Procedure

  • Catheters are removed, and the incision is closed.
  • Patients are monitored closely for several hours to days, depending on recovery.

Post-Surgery Information

Hospital Stay: Typically 1 - 3 days.

Medications: You may be prescribed blood pressure medications and antiplatelet agents.

Activity: Avoid heavy lifting for several weeks. Gradual return to activities is recommended.

Follow-Up: Regular imaging (CT or MRI scans) will be scheduled to ensure the graft remains in place and functions correctly.

Signs to Watch: Chest pain, dizziness, weakness, or leg pain should be reported immediately.

A structured recovery plan and close follow-up care are essential for long-term success.

Potential Risks

While TEVAR is generally considered safe, like any medical procedure, it does carry some risks. Possible complications include:

  • Endoleak (when blood continues to flow into the aneurysm sac despite the graft)
  • Infection
  • Graft migration (movement of the stent graft from its intended position)
  • Spinal cord ischemia, which can lead to leg paralysis
  • Heart attack
  • Stroke

Your healthcare provider will discuss these risks with you in detail and explain the strategies they use to minimize them in your specific case.

Why TEVAR may be the best choice

Healthcare professionals often recommend Thoracic Endovascular Aortic Repair (TEVAR) instead of open surgical repair for several key reasons:

  • TEVAR offers similar success rates in treating the aortic problem as open surgery.
  • Recovery tends to be faster and less demanding, with shorter hospital stays.
  • The procedure carries a lower risk of major complications or mortality.
  • TEVAR avoids the need for a thoracotomy, meaning no large chest incision is required.
  • Patients generally experience less blood loss and reduced post-procedure pain.
  • There is a lower chance of organ damage caused by disrupted blood flow (known as end-organ ischemia).

How Effective Is TEVAR?

TEVAR is highly effective and is associated with better survival rates than traditional open surgery. Approximately 98% of patients safely undergo TEVAR, compared to about 88%–94% survival with open surgical repair. The best outcomes are typically seen at specialized aortic care centers where teams focus specifically on managing complex aortic conditions.

Why Choose RIVEA?

At RIVEA Vascular Institute, Dr. Karthik Mikkineni is redefining aortic care in India. One of the very few U.S.-trained vascular surgeons with American Board of Surgery certification, Dr. Mikkineni performs Thoracic Endovascular Aortic Repair (TEVAR) with unmatched precision, often through just a needle hole, without a single incision. He is also among the select few in the country performing branched and subclavian branch endografts, complex TEVAR procedures that help patients avoid open debranching surgery.

While traditional aortic surgery requires up to 8 days in the hospital, Dr. Mikkineni’s advanced, minimally invasive approach gets most patients home in under 24 hours. This level of expertise—once only available at renowned American institutions—is now at your doorstep in Hyderabad. Dr. Karthik Mikkineni at RIVEA is setting new standards for vascular care in India.

FAQs

What is the recovery time after TEVAR?

Most patients are discharged within 1 to 7 days after the procedure, depending on their condition and any complications. Full recovery varies, but here are typical guidelines:

  • Driving: Usually after 1–2 weeks, with your provider’s approval.
  • Bathing: Avoid soaking baths until groin incisions fully heal. Showers or sponge baths are generally fine.
  • Heavy lifting: Avoid lifting anything heavier than 10 pounds (about 4–5 kilograms) for 1–2 weeks.
  • Lifestyle: Your provider may recommend long-term changes, such as following a heart-healthy diet, quitting smoking, and maintaining regular physical activity.

How important are follow-up appointments after TEVAR?

Follow-up care is essential and lifelong. Regular imaging ensures the stent graft remains in the correct position and detects any potential complications, such as endoleaks. Standard follow-up schedule:

  • 1 month after the procedure
  • 6 months (if needed, based on initial follow-up findings)
  • 12 months after the procedure
  • Every year thereafter

When should I contact my healthcare provider?

Reach out to your care team if you experience:

  • Pain, swelling, or signs of infection at the incision site.
  • Unusual fatigue or symptoms affecting your daily activities.
  • Any questions or concerns about medications, recovery guidelines, or lifestyle changes.

When should I seek emergency care?

Call your doctor or visit the nearest emergency center immediately if you notice signs of:

  • Heart attack: Chest pain, shortness of breath, nausea, sweating.
  • Stroke: Sudden weakness, numbness, difficulty speaking, loss of balance, or severe headache.

These symptoms are medical emergencies and require urgent attention.

Is TEVAR considered open-heart surgery?

No. TEVAR is a minimally invasive endovascular procedure, not open-heart surgery. Instead of opening the chest, surgeons insert a catheter through a small incision—usually near the femoral artery in your thigh.

Using guided imaging, they position a stent graft inside the aorta to strengthen the vessel walls and protect against rupture or dissection. TEVAR helps redirect blood flow away from weakened areas without requiring a large surgical incision.

How long does the TEVAR procedure usually take?

TEVAR procedures typically take 2 to 4 hours, depending on the complexity of the aneurysm or dissection.

Will I feel pain during or after TEVAR?

You’ll be under general or local anesthesia with sedation during the procedure, so you won’t feel pain. Afterward, you may experience mild discomfort at the incision site or general fatigue, which should improve within days to weeks.

How long does a TEVAR stent graft last?

TEVAR stent grafts are designed to be permanent, but regular follow-up is required to monitor their position and function. In some cases, additional procedures may be needed if complications like endoleaks develop over time.

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