Descending thoracic aortic repair and replacement
Open surgical repair is recommended for patients with aneurismal dilatation of the descending thoracic aorta (diameter of the descending aorta exceeding 5.5 cm) from chronic dissection, particularly if the aneurismal dilatation is associated with a connective tissue disorder. The operation requires temporary interruption of the blood flow in the area of the aneurysm, resection of the diseased segment and replacement with a prosthetic tube. During this critical stage of the operation, a bypass device is utilized to route blood around the area of the operation to perfuse with blood vital organs of the body. Also, a variety of other techniques are utilized to decrease the rate of paraplegia (loss of motor function of the legs).
For patients with degenerative or traumatic aneurysms of the descending thoracic aorta exceeding 5.5 cm, saccular aneurysms, postoperative pseudoaneurysms or chronic dissection endovascular stent grafting is utilized when feasible. Endovascular surgery uses minimally invasive techniques that allow insertion of a metal scaffold covered by prosthetic material in the area of an aneurysm. The stent graft is then anchored above and below an aneurysm, thus effectively excluding the aneurysm from the circulation. The success of this technique depends on the presence of enough length of the good aorta (at least 2 cm) above and below an aneurysm that can be used to anchor the stent graft.