Thoracic Endovascular Aortic Repair
What is thoracic endovascular aortic repair (TEVAR)?
Thoracic endovascular aortic repair (TEVAR) is a procedure to treat an aneurysm in
the upper part of your aorta. The aorta is your body’s largest artery. An aneurysm
is a weak, bulging area in the aorta wall. If it bursts (ruptures), it can be deadly.
TEVAR is a minimally invasive surgery. That means it is done with a small cut (incision).
With TEVAR, a device called a stent graft is used to reinforce the aneurysm. A stent
graft is a metal tube covered in fabric. It helps prevent the aneurysm from bursting.
Why might I need a TEVAR?
The aorta is your body’s largest artery. It carries oxygen-rich blood from your heart
to the rest of your body. It goes from your heart through your chest and into your
belly (abdomen). It then divides into blood vessels that provide blood flow to your
Sometimes a weak area of the aorta bulges out. This is called an aortic aneurysm.
An aneurysm of the aorta is serious because it can burst. The risk of bursting grows
as the aneurysm gets bigger. Treatment depends on the size of the aneurysm. Treatment
also depends on how fast the aneurysm is growing.
Your healthcare provider may recommend TEVAR to fix an aneurysm in the part of the
aorta that is in your chest. This is called the thoracic area.
What are the risks of TEVAR?
As with any procedure, problems can occur. Some possible complications may include:
- Injury to nearby organs
- Blood clots
- Risks from anesthesia
- Kidney damage from dye used during the X-ray when the stent graft is put in place
- Device or delivery failure
- Blood vessel injury
- Leaking graft
- The graft moves out of place
- Loss of a leg
- Traditional open surgery may be needed
- Your aortic aneurysm may keep growing after surgery
You may have other risks depending on your specific medical condition. Be sure to
discuss any concerns with your healthcare provider before the procedure.
How do I get ready for TEVAR?
Ask your healthcare provider to tell you what you should do before TEVAR. Below is
a list of common steps that you may be asked to do.
- Your healthcare provider will explain the procedure to you. Ask him or her any questions
you may have.
- You will be asked to sign a consent form that gives permission to do the procedure.
Read the form carefully and ask questions if anything is not clear.
- Your healthcare provider will take your medical history and may do a physical exam.
This is to be sure you are in good health before the procedure. You may also have
blood tests and other diagnostic tests.
- Tell your provider if you are pregnant or think you may be pregnant.
- Tell your provider if you are sensitive to or are allergic to any medicines, latex,
iodine, tape, contrast dyes, and anesthesia medicines (local and general).
- Tell your provider about all the medicines you take. This includes both over-the-counter
and prescription medicines. It also includes vitamins, herbs, and other supplements.
- Your healthcare provider may prescribe medicines to take in the days before your surgery.
These medicines can help relax blood vessels, lower blood pressure, and reduce the
risk of your aortic aneurysm bursting.
- If you take any blood-thinning medicines like warfarin or aspirin, tell your healthcare
provider before your surgery. These can raise your risk of bleeding during the procedure.
You may need to stop taking these before the procedure to reduce your bleeding risk.
- You will likely be told not to drink or eat anything for several hours before surgery.
This often means no food or drink after midnight before your surgery.
- If you smoke, stop smoking as soon as possible before surgery. This can improve your
chances for a successful recovery from surgery. It can also improve your overall health.
Your healthcare provider may have other instructions for you based on your medical
What happens during TEVAR?
TEVAR is a minimally invasive procedure. This means it is done with a small cut (incision).
A vascular surgeon and a team of specialized healthcare providers will do the surgery.
Your doctor can explain what to expect for your surgery. This is an example of how
it is done:
- You will be given anesthesia to prevent pain. This may be general anesthesia, which
causes you to sleep through the procedure. Or it may be regional anesthesia, which
numbs a certain part of your body.
- A healthcare provider will carefully watch your vital signs, like your heart rate
and blood pressure, during the procedure.
- Your surgeon may make a small incision in the groin area as well as the arm to get
into the aortic A thin tube (catheter) called a sheath will be placed in the artery.
- Your surgeon will attach a stent graft to the end of the catheter. The stent graft
is a tube made of a thin metal mesh (the stent). It is covered with a thin polyester
fabric (the graft). The tube is collapsed so it is narrow and can fit through your
- Using X-rays as a guide, your surgeon will thread the catheter, with the stent graft
attached, through an artery in your groin to the affected part of your aorta.
- Once the stent graft is in place, your surgeon will expand its metal frame and fasten
it into place.
- The metal frame expands like a spring and attaches tightly to the wall of your aorta. This
provides a stable place for blood to flow. It also stops the aneurysm from bursting.
The blood supply is now cut off from the aneurysm. This makes it shrink over time.
- Your surgeon will remove the catheter. He or she will close the incision and put a
small bandage on the wound.
What happens after TEVAR?
After the procedure, you will spend several hours in a recovery room. Your healthcare
team will watch your vital signs, such as your heart rate and breathing. To help prevent
bleeding, you may need to lie flat for several hours after the procedure.
After surgery, expect to stay in the hospital for at least 3 to 4 days. Your healthcare
provider will tell you more about what to expect.
Plan to have an adult family member or friend drive you home when you leave the hospital.
Recovering at home
- Recovery time from TEVAR is shorter than it is from traditional open surgery for an
- Avoid strenuous activity for at least 4 weeks. Ask your healthcare provider when it
may be safe to drive again. Check your incision site for signs of infection. These
include redness, swelling, pain, and the development of a bulge.
- Report a fever of 100.4°F (38.0°C) or higher to your healthcare provider right away.
- Your healthcare provider may order CT scans at regular intervals. These will check
for leaks, any breakdown of your graft, and other problems.
- Your provider may tell you to take blood-thinning medicines to prevent blood clots.
- Ask your provider what types of foods to eat and what types of foods to avoid. The
recommended diet will depend on all of your healthcare needs.
- Your healthcare team will tell you when to schedule your follow-up appointment to
check your progress and recovery.
- Remember to take all your medicines as prescribed.
Your healthcare provider may give you other instructions, depending on your situation.
Before you agree to the test or the procedure make sure you know:
- The name of the test or procedure
- The reason you are having the test or procedure
- What results to expect and what they mean
- The risks and benefits of the test or procedure
- What the possible side effects or complications are
- When and where you are to have the test or procedure
- Who will do the test or procedure and what that person’s qualifications are
- What would happen if you did not have the test or procedure
- Any alternative tests or procedures to think about
- When and how will you get the results
- Who to call after the test or procedure if you have questions or problems
- How much will you have to pay for the test or procedure