Thoracic Endovascular Aortic Repair (TEVAR)
Date issued: November 2024
For review: November 2026
Ref: B-294/Imaging/RA/Thoracic Endovascular Aortic Repair (TEVAR) v2
PDF: Thoracic Endovascular Aortic Repair TEVAR.pdf [pdf] 211KB
This leaflet tells you about having a Thoracic Endovascular Aortic Repair (TEVAR). It explains what is involved and what the possible risks are. It is not meant to replace informed discussion between you and your doctor but can act as a starting point for such discussions. If you have any questions about the procedure, please ask the doctor who has referred you or the department which is going to perform it.
Referral and consent
The referring clinician should have discussed the reasons for this examination with you in the clinic and you should make sure that you understand these before attending. Before the procedure you will need to sign a consent form, if one hasn’t been previously completed. This form says that you need to know what risks are involved. This is a legal requirement and ensures that you are fully informed about your procedure.
If after discussion with your hospital doctor or Interventional Radiologist (a doctor who has trained and specialised in imaging and x-ray treatments) you do not want this examination, then you can decide against it.
At all times the radiologist and referring clinician will be acting in your best interests.
What is a TEVAR?
Thoracic Endovascular Aortic Repair (TEVAR) is a way of repairing an abnormality in the main blood vessel leaving your heart (aorta) by inserting covered metal mesh tubes (stent grafts). The stent grafts are typically inserted in a minimally invasive manner via the arteries in you groin using X-ray guidance to position them accurately. It is an alternative procedure to the conventional major open surgical repair to the aorta.
Why do you need a TEVAR?
You will have already had imaging, either a Computed Tomography (CT) or a Magnetic Resonance Imaging (MRI) scan, to look at the aorta in your chest. You may have also had a coronary angiogram. The tests have shown that the aorta in your chest is either enlarged (aneurysm) or has developed a split in its lining (dissection). The size of the aneurysm is such that there is a risk of it bursting (rupture) or the dissection is leaking or preventing blood flowing into the legs. This is a very serious problem, and most people will not survive a rupture. Repairing the aorta before it ruptures or leaks usually has good results. Repair can either be done with a major surgical operation to replace the thoracic aorta or the aorta can be ‘relined’ from the inside with a stent graft. Not all patients are suitable for TEVAR but imaging has shown that yours is.
Are there any risks?
TEVAR is a major but normally safe procedure. There are a number of risks and complications that can arise. They are relatively rare; some are less than a major surgery, others are about the same.
There can be damage to the blood vessels through which the tubes are placed, damage to the aneurysm causing a leak or graft migration. This may require other radiological procedures or conversion to a major surgical repair.
Occasionally, because of the size of your blood vessels, it may not be possible to insert the stent graft and surgical conversion may also be required. These complications are rare, with the risk about 1%.
The abnormality in your aorta is close to the origins of blood vessels that supply your brain and spinal cord. These blood vessels can sometimes be blocked by the stent graft or the flow through them altered in some way. This can result in a stroke or paralysis of your legs. The risk is about 2–3%.
The stent graft may not completely seal the aneurysm allowing it to continue to fill and grow in size. Small leaks are quite common and usually require no additional treatment. Some larger leaks may require a further procedure.
Occasionally arterial wall material may be dislodged, an embolus (clot). This may cause your legs to lose blood supply and require surgery (or very rarely amputation).
Kidney damage can occur due to a high volume of contrast agent (x-ray dye) used in this procedure or the stent can block the arteries that supply the kidneys.
It is extremely rare that the stent may become infected. This requires lifelong antibiotics and sometimes removal of the stent graft with major surgery.
There are small risks related to the anaesthetic which will be explained to you by your anaesthetist.
If you are pregnant or suspect that you may be pregnant you should notify the department. A baby in the womb may be more sensitive to radiation than an adult. There is no problem with something like an x-ray of the hand or chest because the radiation field is at a safe distance from the foetus. However, special precautions are required for examinations where the womb is in, or near, the beam of radiation. If you are a female of childbearing age the radiographer will ask you if there is any chance of you being pregnant before the examination begins and you will be asked to sign a form. If there is a possibility of pregnancy, then your case will be discussed with the team looking after you to decide whether or not to recommend postponing the investigation.
There will be occasions when diagnosing and treating your illness is essential for your health and where the benefit clearly outweighs the small radiation risks. The procedure may go ahead after discussing all the options with you.
Are you required to make any special preparations?
You need to be an inpatient for the procedure. You will be asked not to eat or drink for six hours before the procedure.
If you are taking warfarin, rivaroxaban, apixaban, ticagrelor (anticoagulants) this will be stopped before the procedure and you may require admission to hospital to give you an alternative.
If you have any allergies or have previously had a reaction to the dye (contrast agent), you must tell the radiology staff before you have the test.
Who will you see?
A team of doctors, including a vascular surgeon and a specially trained doctor, called an Interventional Radiologist, perform the procedure. Interventional Radiologists have special expertise in reading the images and using imaging to guide catheters and wires to aid diagnosis and treatment.
Where will the procedure take place?
You will be admitted to a ward prior to the procedure. You will be asked to get undressed and put on a hospital gown. A small cannula (thin tube) will be placed into a vein in your arm. You may require a fluid drip to help your kidney function before the procedure. Our porters will collect you and bring you to the interventional radiology suite which is located within
X-ray East. This is similar to an operating theatre into which specialised X-ray equipment has been installed.
What happens during a TEVAR?
Before TEVAR, your team will explain the procedure and ask you to sign a consent form, if one hasn’t previously been completed. Please feel free to ask any questions that you may have and, remember that even at this stage, you can decide against going ahead with the procedure if you so wish.
The procedure is performed under sterile conditions and the Interventional Radiologist, and a surgeon will wear sterile gowns and gloves. Small incisions are made in your groins to expose the artery.
Once the artery is exposed within the groin, a guide wire and catheter (fine plastic tube) will be inserted into the artery and guided to the correct position to obtain the images required. The stent graft is introduced from the groin and positioned using the X-ray equipment; dye (contrast agent) is injected into the blood vessels to check the position. Once completed, the tubes and wires are removed and the arteries in the groin closed with stitches/special closure devices.
Will it hurt?
There may be a little discomfort related to the groin incisions for a few days afterwards. This usually settles quickly and can be controlled with painkillers. You will not feel the stent graft inside you.
How long will it take?
Every patient is different, and it is not always easy to predict; however, on average the anaesthetic and procedure will take two or three hours.
What happens afterwards?
You will be returned to a special unit to recover from the anaesthetic. You will normally go to a dependency unit for close observation for approximately 24 hours. You should be fit for discharge after 3–5 days.
There is a small chance that your aneurysm will continue to fill after a stent graft is inserted or the graft may move. It is important that this is checked regularly with CT or MRI imaging. The first scan will be soon after the insertion with increasing intervals thereafter.
Other Risks
A TEVAR is a major but normally safe procedure but as with any procedure or operation complications are possible. We have included the most common risks and complications in this leaflet.
We are all exposed to natural background radiation every day of our lives. This comes from the sun, food we eat, and the ground. Each examination gives a dose on top of this natural background radiation.
Any exposure to ionising radiation (e.g. X-rays) has the potential to cause cancer later in life. This is much lower than the risk we all have of developing cancer in our life of 1 in 3 and will be considered by the doctor before your procedure.
For information about the effects of X-rays read the publication: “X-rays how safe are they” on the Health Protection Agency
website: www.hpa.org.uk
Finally
Some of your questions should have been answered by this leaflet but remember that this is only a starting point for discussion about your treatment with the doctors looking after you. Make sure you are satisfied that you have received enough information about the procedure.
Contact
Interventional Radiology Department
01752 432063 – Bookings Clerk
01752 430838 – IR Co-ordinator
Additional Information
Bus services:
There are regular bus services to Derriford Hospital. Please contact:
Car parking:
Hospital car parking is available to all patients and visitors. Spaces are limited so please allow plenty of time to locate a car parking space. A charge is payable.
Park and Ride:
Buses (1/1A/42C/34) run from the George Junction Park and Ride Mon-Sat (except Bank Holidays) every 15/20 mins from 6am. The last bus leaves the hospital at 11:30pm.
Plympton Park and Ride (52) runs from Coypool Park and Ride.
Parking is free although you will need to purchase a ticket to travel on the bus.
Patient Transport:
For patients unable to use private or public transport please contact The Patient Transport Service:
Devon GP: 0345 155 1009
Cornwall GP: 01872 252211
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