TEVAR — Thoracic Endovascular Aortic Repair in Hyderabad

Traditionally, disease of the descending thoracic aorta required a thoracotomy — opening the chest, deflating a lung, and often using cardiopulmonary bypass to safely clamp and replace the diseased segment. This was major surgery with significant risks of bleeding, paraplegia from spinal cord ischemia, and prolonged recovery.

TEVAR achieves the same goal — excluding the diseased aortic segment — through a small groin access. A covered stent-graft is advanced over a wire from the femoral artery, up through the abdominal and thoracic aorta, and deployed under fluoroscopic guidance to seal the aneurysm, ulcer or dissection entry tear from within.

Because the chest is never opened, patients avoid the pain of rib retraction, lung complications and the weeks of recovery typical of open thoracic surgery. Most TEVAR patients are extubated on the table and mobile within a day.

An aortic dissection occurs when a tear develops in the inner lining of the aorta, allowing blood to split the vessel wall into a true and false channel. Type A dissections (involving the ascending aorta near the heart) are surgical emergencies needing open cardiac surgery. Type B dissections (starting beyond the left subclavian artery) are often initially managed with aggressive blood pressure control alone.

However, when a Type B dissection is 'complicated' — causing malperfusion (blood-starved organs or limbs), uncontrollable pain, rapid expansion or impending rupture — TEVAR becomes the standard of care and can be genuinely life-saving. The stent-graft covers the primary entry tear, redirecting blood flow into the true lumen and restoring perfusion to the abdominal organs and legs.

Timing matters enormously here: patients presenting with sudden tearing chest or back pain radiating between the shoulder blades should be evaluated as a vascular emergency, since untreated complicated dissection carries a very high mortality within hours to days.

The spinal cord receives part of its blood supply from small arteries branching off the thoracic aorta. Covering a long segment of aorta with a stent-graft can, in a minority of patients, reduce this supply and risk temporary or permanent leg weakness (spinal cord ischemia) — a serious but preventable complication.

Dr. Sharma mitigates this risk through careful graft-length planning, staged procedures for extensive disease, maintaining adequate blood pressure during and after the procedure, and, in higher-risk cases, using a temporary cerebrospinal fluid (CSF) drainage catheter to reduce pressure around the spinal cord.

When an aneurysm extends close to the aortic arch, covering the left subclavian artery may be necessary to get a secure seal. In such cases, a carotid-subclavian bypass or a chimney/branched technique preserves blood flow to the left arm and posterior brain circulation, avoiding arm claudication or vertebrobasilar symptoms.

Most patients spend 24–48 hours in intensive care for close blood pressure and neurological monitoring, followed by a further 2–3 days on the ward before discharge — considerably shorter than the 10–14-day stay typical after open thoracic aortic surgery.

Blood pressure and heart rate control become the cornerstone of long-term care after TEVAR, since ongoing hypertension is the single biggest driver of late complications, whether the original problem was an aneurysm or a dissection. Beta-blockers are frequently continued indefinitely even after apparently successful repair.

Structured CT surveillance at one, six and twelve months, then yearly, tracks stent-graft position, seals the aneurysm sac shrinkage or persisting false lumen flow in dissection patients, and catches any late complication before it becomes symptomatic.

High-speed road traffic accidents and falls from height can cause a traumatic aortic transection — a partial tear of the thoracic aorta that, if untreated, is rapidly fatal. TEVAR has transformed the management of this injury, allowing a life-saving stent-graft to be placed rapidly, often in the same admission as other trauma care, without the added physiological insult of open chest surgery in an already critically injured patient.

This emergency capability depends on round-the-clock availability of appropriately sized stent-grafts and a surgeon experienced in rapid aortic imaging interpretation and deployment — a combination Dr. Sharma's team maintains for trauma and vascular emergencies referred to Renova Century Hospital.

Even in the emergency setting, the same principles apply: precise sizing from CT, careful attention to the landing zones near the arch vessels, and a clear surveillance plan once the patient has stabilised.