Patient information:
TAAA (Thoraco Abdominal Aortic Aneurysm)?
‘Aneurysm’ is the name given to the widening of a blood vessel. The aorta – our largest blood vessel – can also widen and form an aneurysm. The aorta is the body’s largest artery. It starts in the heart and runs through the chest, along the spinal column, through the diaphragm to the belly (abdomen), and ultimately divides into the pelvic arteries. As a rule of thumb, an aneurysm is diagnosed when the diameter of the aorta has reached 1.5 times the normal width. Aneurysms are caused by weakening of the vessel wall.The aorta can widen at any point. The most common aneurysm occurs in the abdominal aorta (AAA, i.e. in the belly). However; thoracic aneurysms are also possible (in the chest, TAA). The most extensive cases involve both the thoracic and the abdominal segments of the aorta (belly and chest, TAAA). The information below concerns TAAA. The principal causes of an aneurysm are calcification (atherosclerosis), degeneration as the result of an imbalance between the proteins that build the vessel walls and others that break it down, hereditary factors and inflammation.
Operations are only carried out if the aneurysm is extremely likely to burst, or if it is growing rapidly. Two types of operation are possible: open surgery, or endovascular surgery. Endovascular procedures are generally preferred due to the reduced likelihood of complications. However, if the aorta has a very abnormal shape or tissue structure not allowing endovascular repair, open surgery will be performed. Also, open surgery is the preferred method in young patients (for example with Marfan disease).
Open surgery
In a TAAA operation, the widened section of the aorta is replaced with a synthetic implant. The surgeon makes an incision from the side of the back, across the ribcage (the place on the front of your body where the ribs meet) and down towards the umbilicus (the belly button). This is the only way to gain effective access to the entire aorta. The surgeon will then replace the widened section of the aorta with a synthetic prosthesis, attaching the branches of the aorta to the new synthetic one. These branches supply blood to the spinal cord and important organs in the abdomen. The surgeon does not remove the damaged section of the aorta, but covers it around the new synthetic blood vessel in order to protect it from the surrounding tissues.
Endovascular Aneurysm Repair (EVAR)
This is referred to as a ‘less invasive’ procedure, which means that the operation is performed through small incisions (keyholes). Thin tubes (catheters) are inserted through an incision in the pelvis, and used to position stent grafts at the location of the aneurysm. Openings are made in the stent graft wherever the artery branches off to other organs. If necessary, these branches can also be reinforced with smaller stents. The advantage of this procedure is that there is less damage to the body’s tissue, which means shorter recovery time and less chance of infection.