EVAR & TEVAR

Before the 2000s, Aortic Surgery was among the most complex and complication-prone surgeries in Cardiovascular and Vascular Surgery. However, advancements in technology have made Aortic surgeries easily achievable through what we call “closed” methods. Aortic aneurysm is one of the most dangerous diseases. An aortic aneurysm either ruptures outward causing bleeding or dissects inwardly, resulting in tearing inside. Both scenarios pose a significant risk of death. To prevent these complications, aneurysms reaching a certain size are surgically intervened. In open surgery, either by fully opening the chest or abdomen, the aneurysmal aorta is removed and replaced with a “synthetic” vessel.

There’s also the “closed” Aortic Surgery mentioned above, performed on an angiography table or under “hybrid” operating room conditions. In this method, instead of open surgical techniques, endovascular repair is performed using wires and catheters inserted through the groin without making incisions in the abdomen or chest, for appropriate aneurysms. Here, a catheter (thin plastic tube) carrying an artificial vessel is advanced from the groin artery into the diseased portion of the abdominal aorta, and the artificial vessel is deployed by lining it within the patient’s vessel, without making an additional incision. Thus, the aneurysm can be treated from the inside without making an incision in the groin. Over time, the aneurysm containing the artificial vessel diminishes, indicating successful treatment. This procedure should be performed under X-ray guidance and sterile operating room conditions. The procedure typically takes about 1-2 hours and can even be performed under local anesthesia. Hospital stay is usually 1-2 days, and intensive care unit admission may not be necessary. However, in case of any complications (such as stent migration, blockage of the kidney or another major vessel, bleeding, etc.), there is a possibility of reverting to open surgery. Although this probability is low, it varies depending on anatomical structure and the team’s experience. It is imperative that the procedure is performed in a clinic where such situations can be easily treated and under the supervision of a Cardiovascular and Vascular Surgeon.

Additionally, patients require regular follow-up appointments. The aneurysm sac surrounding the artificial vessel may start to revascularize even after years. This problem, called “Endoleak,” may require further endovascular intervention or surgery for treatment. Not all aneurysms can be treated with endovascular methods. For some aneurysms, open surgical repair remains the most reliable method.

The Aorta within the chest consists of 3 sections: the Ascending Aorta, Arch of the Aorta, and Descending Aorta. These aneurysms can grow silently without any symptoms. Sometimes they are diagnosed incidentally during examinations for back pain symptoms. An Ascending Aortic aneurysm with a diameter of 5.5 cm or more poses a life-threatening risk to the patient. As its wall thins and ruptures, blood can rapidly spread into the heart cavity, compressing it and causing it to stop. Therefore, treatment is mandatory. Surgery is inevitable for the Ascending Aorta, and endovascular (closed) treatments are not suitable. However, with a small incision, this vessel can be replaced from 3-4 cm upwards (See Endovascular Aortic and Aortic Valve Replacement Closed Method). The Descending Aorta, located in the back, is suitable for endovascular treatment. This means it can be replaced via the TEVAR method without opening the chest cage.