Case Study By Carlos Bechara, MD
Case Study By Carlos Bechara, MD
A male patient in his 70s had multiple comorbidities: coronary artery disease, cancer, hypertension and previous aneurysm repair. He was being followed by Rush vascular surgeons for a thoracic aneurysm.
He previously had open abdominal aneurysm surgery that was complicated and, in addition to other risk factors listed above, he was not a candidate for open repair.
He was offered thoracic endovascular aneurysm repair (TEVAR) to treat the aneurysm.
In February 2025, the patient’s aneurysm had enlarged and reached a critical size of more than 7 cm, which put the patient at risk of rupture and death. I discovered this during a follow-up in clinic and, luckily, the patient was asymptomatic (i.e., no back pain).
These types of aneurysms are best identified and treated before they become symptomatic; otherwise, they have fairly high mortality despite repair. He was seen by our cardiology colleagues and deemed stable for a TEVAR.
We had a discussion with the patient about the risks of leaving it alone versus doing TEVAR. The risks favor proceeding with TEVAR. The two biggest risks with this procedure are spinal cord ischemia (SCI) and stroke.
Thoracic endovascular aneurysm repair (TEVAR) is a minimally invasive procedure used to treat aneurysms in the thoracic aorta by placing a stent graft through a small incision in the groin to reinforce the weakened section of the artery. This approach reduces the risks and recovery time compared to open surgical repair.
The patient decided to proceed with TEVAR, which was done in the hybrid operating room that allows us to do surgery and perform X-ray to properly place the stent.
We also placed a spinal drain to reduce the risk of spinal cord injury. As for the risk of stroke, the etiology is multifactorial, but one source is believed to be air released during stent deployment. To reduce the risk of stroke from air embolism, we used a newly FDA-approved device with CO² flushing to remove air from the stent. This is done prior to inserting the stent in the patient’s aorta. It was fast and low cost to do, and I recommend that it should be done in every TEVAR procedure to eliminate one potential source of stroke.
The patient did very well and was discharged without any complications. He was very pleased with the result. Most importantly, his large thoracic aneurysm is now fixed, and he does not have to worry about it anymore. A postoperative CT scan was done, which showed great stent placement and no migration or endoleak.
TEVAR should be done by highly specialized cardiologists in quaternary care centers like Rush. As chief of vascular surgery at Rush, I have extensive experience in treating patients with aortic aneurysms and dissection. I was the first clinician in the Midwest to use the newly FDA-approved stent graft with CO² flushing. It is important to bring this technology to our patients who will benefit from these advances to reduce cardiovascular complications, particularly when it could be as devastating as a stroke.
