Massive life threatening Thoracic Aortic aneurysm – a rare condition, treated with TEVAR approach at Apollomedics Super Specialty Hospital, Lucknow.

Dr Vijayant Devenraj, Senior CTVS Consultant at the Apollomedics Super Specialty Hospital, Lucknow and his team have recently performed a minimal invasive procedure (TEVAR- Thoracic EndoVascular Aortic Repair) to save the life of a 52-year-old man from Lucknow suffering with potentially life threatening (impending rupture) huge thoracic aortic aneurysm, a rare condition.

The doctors explained that aortic aneurysm is a pathological balloon like bulge in the aorta (the main artery that carries blood from heart to the rest of the body).

The 52-year-old Ramoram, was suffering with a thoracic aortic aneurysm since 2020 and had experienced pain in his chest, but due to the COVID-19 pandemic, had delayed his treatment. Recently, when he experienced unbearable pain in his chest and back, he decided to visit the doctors at (Emergency department) of Apollomedics Super Specialty Hospital, Lucknow in the third week of January.

After thorough evaluation and investigations, the doctors found that the patient’s thoracic aorta had a bulge of 9 cms in width and 18 cms in length with blood clots around (signs of blood leak and nearing rupture). The patient was immediately admitted in ICU and vitals stabilised.

The doctors said that beyond 5 cms the aortic aneurysm could be fatal as it could rupture any time. For treating the patient, the doctors used the Thoracic endovascular aortic repair (TEVAR) method. As the aneurysm was very large it required placement of two stented aortic grafts of 30 cms each into the thoracic aneurysm. This is known as aortic stent graft into another aortic stented graft, a very challenging endovascular procedure.

The aortic stent-in stent grafts made a route for the blood to flow into the body without forming a bulge.

The data has also shown that this condition happens in only 1% of the population in India and the primary reasons are atherosclerosis, genetic, (Marfans etc.) followed by hypertension and lack of exercise, and following major blunt trauma. However, only 50% people suffering with aortic aneurysm survive if treatment is given on time.

Dr Vijayant Devenraj, Senior Consultant Cardiothoracic & Vascular Surgery at Apollomedics Super Specialty Hospital, Lucknow said, “The TEVAR procedure is very complex as the placement of the graft in the aorta must be very precise. The aneurysm may rupture during the procedure. There may be dissection that is again a dreaded disease. If the graft gets place above or below the affected place, it can cause spinal paralysis. Earlier open surgical repair was the only option and carried lots of morbidity and mortality. TEVAR is a modern method to treat such complex cases as it results in reduced blood loss, low chances of infection and shorter stays at the hospital and is minimally invasive.”

The doctor also injected a word of caution for people to never ignore severe non relenting pain in their chest and back simultaneously, which could be a sign of thoracic aortic aneurysm. “If one experiences a similar pain in the chest and back they must keep a watch on their blood pressure and visit the doctors at the earliest”, added Dr Vijayant.

The team comprised of Dr Tarun Bansal (Cardiologist), Dr Sarkar and Dr Kushal Hajela (Cardiac Anaesthetist), Dr Munshi (CTVS Surgeon), Ms Navneet Devenraj (Perfusionist), Dr Ashish Rai, Dr Sushil (ICU incharge) and team CTVS.