Panama Medical Vacations
Thoracic Aortic Aneurysm Surgery in Panama
The largest artery in your body, the aorta moves blood from your heart to the other parts of your body. The thoracic aorta is the portion that runs through your chest and the abdominal aorta services your abdomen. When a weak section of your thoracic aorta expands or bulges, it is called a thoracic aortic aneurysm. Approximately 25 percent of aortic aneurysms occur in the chest, and the rest involve the abdominal aorta.
A special type of thoracic aneurysm is called an aortic dissection, and is usually associated with high blood pressure. Sometimes, blood flow forces the layers of the wall of your aorta apart, and it weakens your aorta and can cause TAA. The separation can extend from your thoracic aorta through your entire aorta and block arteries to your legs, arms, kidneys, brain, spinal cord, and other areas. Another problem associated with aortic dissection is that over time, the pressure of blood flow can cause the weakened area of your aorta to bulge like a balloon. Much like an over-inflated balloon, an aneurysm can stretch the aorta beyond its safety margin.
Thoracic aortic aneurysms are a serious health risk because they can burst or rupture. A ruptured aneurysm can cause severe internal bleeding, which can lead to shock or death.
Thoracic aneurysms affect approximately 15,000 people in the United States each year. Some patients may have more than one TAA or may also have an aneurysm in the abdominal aorta. Only about 20 to 30 percent of patients who get to the hospital with a ruptured TAA survive. For this reason, it is crucial to treat large aneurysms early in order to prevent their rupture.
The Procedure
There are two treatment plans for a thoracic aortic aneurysm. The first is the traditional open surgical repair and the second is the endovascular stent graft repair. The procedures for these are:
Open Surgical Repair
In an open surgical repair, your surgeon makes an incision in your chest and replaces the damaged portion of the aorta with a fabric mesh tube, called a graft. The graft strengthens the weakened aorta and transports blood without causing a bulge. Many patients who have a thoracic aortic aneurysm also have heart disease or involvement of the aorta adjacent to the heart. When a complex thoracic aneurysm surgery is required, it is possible the heart surgery will be performed at the same time as open aneurysm repair.
Endovascular Stent graft repair
Instead of open aneurysm repair, your surgeon may use a promising new procedure called an endovascular stent graft. The term endovascular means that the procedure is performed inside your body using long, thin catheters. The catheters are inserted in small incisions in your groin and are threaded through your blood vessels.
During this procedure, your surgeon will use live x-ray pictures viewed to guide the stent-graft to your aneurysm. Like the graft used in open surgery, this stent permits blood to flow through your aorta without extra pressure on the damaged wall of your aneurysm. This prevents your aneurysm from rupturing. Over time, your aneurysm will shrink.
Your aneurysm must have a suitable shape to allow the stent-graft to be used effectively. With the endovascular stent-graft repair, long-term follow-up with periodic scans of the aortic repair is important to be sure that the stent-graft is working properly.
After your surgery
Your post-surgery recovery will depend on the procedure you have. For an open surgical repair, you may stay in the hospital for 5 to 7 days after the procedure. If your thoracic aortic aneurysm surgery is extensive or complex, you may require 2 to 3 months for a complete recovery.
With an endovascular stent-graft repair, the required hospital stay and following recovery are shorter than with open aneurysm repair. Your hospital stay is reduced to 2 or 3 days and you will begin the process of recovery immediately following the procedure.
Risks
Thoracic aortic aneurysm procedures are complex but relatively safe. Possible complications from the graft include:
- Leaking of blood around the graft, known as “endoleak”
- Movement, or migration, of the graft away from its initial placement
- Stent fracturing
In addition these serious complications can occur:
- Paralysis
- Delayed rupture of the aneurysm
- Infection