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Branched EVAR Treatment For Thoracoabdominal Aneurysm


The aorta is the main and largest artery in the human body, originating from the left ventricle of the heart and extending down to the abdomen, where it splits into two smaller arteries (the common iliac arteries). The aorta distributes oxygenated blood to all parts of the body through systemic circulation.

An aortic aneurysm is a bulging, dilation, or ballooning in the wall of a blood vessel, usually an artery, which occurs due to weakness or degeneration that develops in a portion of the artery wall. Just like a balloon, the aneurysm enlarges, stretching the walls of the artery thinner and compromising the artery wall’s ability to stretch any further. At this point, an aneurysm is at risk of rupturing or dissecting the artery wall, causing potentially fatal bleeding. Dissections and ruptures are the cause of most deaths from aortic aneurysms.

An aneurysm that occurs in the thoracic aorta, located in the chest beyond the arteries to the head and neck, is called a thoracic aortic aneurysm (TAA). Aneurysms can also involve both the chest and abdomen, a condition called thoracoabdominal aortic aneurysm (TAAA).

Thoracoabdominal Aneurysm treatment at Sheba Medical Center in Israel.

What are the risk factors for an aortic aneurysm?

Diseases and unhealthy habits that damage your heart and blood vessels increase your risk for aortic aneurysms. These include smoking, considered one of the leading causes of aortic aneurysms.
Other factors include:

  • High blood pressure
  • High blood cholesterol
  • Atherosclerosis (hardened arteries)
  • Age 65 or over
  • Being male
  • Family history of aneurysms
  • Diabetes
  • Genetic disorders
  • Blood vessel diseases
  • Infection in the aorta
  • Trauma
  • Symptoms

    Most patients with aneurysms have no symptoms until their aneurysm is in the process of rupturing. When that occurs, common symptoms include:

  • Shortness of breath
  • Trouble breathing or swallowing
  • Severe or dull pain in the abdomen, chest, lower back, or groin
  • Clammy, sweaty skin
  • Dizziness, nausea, and/or vomiting
  • Lightheadedness
  • An elevated heart rate
  • Diagnosis

    In addition to asking for your complete medical history and conducting a physical exam, your physician may order a computed tomography (CT) scan and/or a magnetic resonance imaging (MRI) scan.

    How are aortic aneurysms treated?

    The goal of thoracoabdominal aneurysm treatment is to prevent the aneurysm from growing and rupturing. Treatment depends on the aneurysm's size and how fast it's growing. Aortic aneurysms are treated mainly by medications and surgery. Medications can lower blood pressure and reduce the risk of an aortic aneurysm, while surgery can repair or replace the affected section of the aorta. Traditionally, thoracoabdominal aneurysms are treated with the following complex surgeries:

    Open-chest surgery

    This surgery generally involves removing the part of the aorta damaged by the aneurysm, which is then replaced with a synthetic tube (graft) sewn into place. Complete recovery may take a month or more.

    Aortic root surgery

    This type of open-chest surgery is done to treat an enlarged section of the aorta to prevent a rupture. During aortic root surgery, a surgeon removes part of the aorta and sometimes the aortic valve. A graft then replaces the removed section of the aorta, while the aortic valve may be replaced with a mechanical or biological valve. If the valve is not removed, the surgery is called valve-sparing aortic root repair.

    Open-chest surgery

    Endovascular Aortic Aneurysm Repair (EVAR)

    EVAR is an advanced, minimally invasive technique for the treatment of thoracic aneurysms available in select medical centers.

    During the procedure, a surgeon inserts a thin, flexible tube (catheter) into a blood vessel, usually in the groin, and guides it to the aorta. A metal mesh tube (graft) attached to the end of the catheter is placed at the aneurysm site, with small hooks or pins to hold it in place. The graft then reinforces the weakened section of the aorta to prevent rupture of the aneurysm. EVAR involves smaller incisions, less pain, and faster recovery times compared to traditional open surgery.

    While EVAR has become a staple in leading medical institutions, it is only suitable to approximately 30 to 40 % of patients since, when it comes to more articulated aortic segments, grafts can interfere with the blood flow to collateral vessels, also known as branches.

    Branched EVAR for Thoracoabdominal Aneurysm Treatment

    Branched endovascular aneurysm repair (B-EVAR) is an advanced procedure designed to enhance the existing EVAR procedure.

    Through the use of unique, branched stent grafts, B-EVAR allows the incorporation of aortic side branches and blood flow preservation while achieving aneurysm exclusion with a total endovascular approach.

    The aortic stent graft can be designed to include any major visceral arteries, and can also be combined with thoracic endovascular stent grafts to manage aneurysms involving the descending thoracic aorta.

    Why Choose Sheba for Branched EVAR?

    The Department of Vascular Surgery at Sheba is dedicated to providing state-of-the-art clinical treatment, as well as conducting groundbreaking studies on vascular disease.

    Our facilities are equipped with a range of progressive technologies to perform surgical and endovascular procedures, in addition to various medical therapies. Highly qualified, experienced specialists operate four outpatient clinics, in which approximately 1,700 patients are treated every year, alongside a specialized vascular access clinic.

    Having treated over 1,300 patients using B-EVAR, Sheba offers expertise no other medical institution can match. Additionally, patients treated at Sheba for thoracoabdominal aneurysms can be provided with ready-made grafts or fitted with a custom-made graft within minutes.

    Dr. Moshe Halak, Director of the Vascular Surgery Department at Sheba, is one of the only physicians in Israel experienced in the cutting-edge stent-graft (JOTEC) treatment for aortic aneurysm. He received his medical degree with honors from the highly regarded Technion Institute’s Faculty of Medicine, and is a member of both the Israeli Medical Association and the Israeli Society of Vascular Surgery.

    To learn more about branched EVAR treatment for thoracoabdominal aneurysms at Sheba, contact us for a free consultation.

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