Endovascular Aortic Surgery
Stanford Health Care offers superior options in cardiac surgery, including the latest techniques, treatments, and research for endovascular aortic surgery. Clinical trials involving stateof-the-art aortic devices and advanced minimally invasive operative techniques give our patients the option of complete aortic repair without needing open-heart surgery.
Hybrid total aortic repair
Aortic Anatomy
The aorta is the body’s largest artery; it carries blood and oxygen from the heart to the rest of the body and organs. A healthy aorta is usually 2-3 cm in diameter.
There are many causes of aortic disease. Some patients inherit aortic disease, or some may develop it during their lifetime. The two most common aortic diseases are aortic aneurysm and aortic dissection.
- An aortic aneurysm occurs when a part of the aorta stretches out larger than 2-3 cm, creating a balloon-like bulge in the blood vessel. Aortic aneurysms are thinner than a normal aorta and more prone to bursting.
- An aortic dissection is a tear in the lining of the aortic wall. The dissected aorta is weaker than normal and more prone to aneurysm formation. Both aneurysms and dissections can lead to an emergency or rupture.
Aorta
Left: Illustration of the top of the aorta, the body’s largest artery. Right: Illustration of the full aorta.
Endovascular Aortic Surgery
The standard surgical approach for aortic disease is to remove and replace the aorta in an open-heart surgery in which the chest and/or abdomen are opened through an incision. Increasingly, patients are seeking a less invasive approach, and technologies are evolving to allow the aorta to be treated with various stenting procedures rather than open surgery.
The Thoracic Endovascular Aortic Repair (TEVAR) uses a metal stent (also called a stent graft) covered in fabric that is inserted within the diseased aorta for repair. The stent prevents blood from entering the aneurysm or dissection and helps prevent the aorta from stretching farther or bursting.
This stent graft was invented and first implanted in a patient at Stanford in 1992. The stent is placed using catheters and wires via a needle puncture in the femoral artery in the groin.
Some patients may require more extensive repairs; therefore, some TEVAR stents have side branches for other arteries — giving more patients the option to be treated via endovascular aortic surgery.
Thoracic Endovascular Aortic Repair (TEVAR)
Illustration of a TEVAR procedure using a stent graft inserted in the diseased aorta for repair.
Patient Experience with Endovascular Aortic Surgery
Stanford Health Care’s multidisciplinary aortic team provides our patients with the highest quality of specialized care.
The team includes cardiothoracic surgeons, cardiovascular surgeons, radiologists, anesthesiologists, cardiologists, and genetic counselors.
Pre-surgical Tests May Include:
• CT scan
• Echocardiogram
• Stress test or coronary angiogram
• Pre-operative blood tests/lab work
• Ultrasounds
Some procedures require the use of a lumbar drain, a small catheter inserted in the spine, to prevent complications. The catheter device is placed before the procedure and stays in for 1-2 days following surgery.
Procedure Details:
• Moderate sedation or general anesthesia
• Ultrasound-guided needle puncture in the femoral artery
• Wire and catheter placement under X-ray guidance
• Intra-operative angiograms before and after stenting
• Advanced adjunctive procedures when needed
Post-surgical Recovery:
• The recovery period will generally be 1-2 days in the ICU and another 1-3 days in the surgical step-down unit. Patients are generally up and walking in the evening or morning after surgery.
• Post-operative CT scan will be performed following the procedure, which will serve as a new baseline for further aortic monitoring.
• Complete recovery will generally be 1-2 weeks from the time of surgery.
Candidates for Endovascular Aortic Surgery
Not all patients are eligible candidates for endovascular surgery. Eligibility factors include age, disease process, aortic anatomy, and connective tissue disorders.
Patients may be eligible for endovascular aortic surgery if they have the following:
• Prior aortic surgeries
• Aortic arch aneurysm or dissection
• Thoracoabdominal aortic aneurysm or dissection
• Abdominal aortic aneurysm or dissection
Stanford Health Care’s surgical team is equally skilled in open, surgical aortic repair, and endovascular aortic surgery. Our team provides patients with all possible and available options and ensures the best repair for their specific problem is offered.
Potential Benefits of Endovascular Surgery
• Avoids a sternotomy or thoracotomy
• Reduced risk of infections
• Minimal or no scarring
• Reduced postoperative pain
• Lower incidence of post-operative atrial fibrillation
• Shorter or no ventilation time
• Shorter hospital stays, typically 3-5 days
• Faster return to an active life, typically 1-2 weeks
Endovascular Aortic Repair Approaches
Examples of complex aortic surgeries using a stent graft
in the diseased aorta.
Transfer Center and Referral Information
Patients and Families (Self-Referral)
The patient’s doctor will request an evaluation by the Stanford Advanced Lung Support team, who will review their previous medical records and determine if additional tests are necessary. After reviewing the patient’s information, the team will provide further details regarding patient transfer. You can call the clinic number below to speak with one of our clinic staff about the status of your referral or self-referral. They will help guide you through the process or next steps needed.
We use a multi-disciplinary approach to diagnose and treat patients with valvular heart disease, offering repair and replacement for heart valves.
Stanford Referral Center and Clinics are staffed Monday through Friday from 8 am - 5 pm (PST)
We have several locations where our surgeons can see you for a consult, offering you convivence closest to your home.
Our main Adult Heart Surgery Clinic & Surgery schedulers number to call for an appointment is: 650-724-7500
Our direct clinic contact information and locations are:
Heart Surgery in Palo Alto
Heart and Vascular Center
300 Pasteur Drive
3rd Floor, Clinic A31
Stanford, CA 94305
Phone: 650-724-7500
Map of Stanford Hospital
Aortic Disease Center
Heart and Vascular Center
300 Pasteur Drive
3rd Floor, Clinic A31
Stanford, CA 94305
650-725-8246
Map of Stanford Hospital
Heart Surgery in Pleasanton
5565 W. Las Positas Blvd.
Suite 320
Pleasanton, CA 94588
Phone: 925-278-7017
Heart Surgery in San Jose
751 S. Bascom Avenue
San Jose, CA 95128
Phone: 408-885-3838
Interested in an Online Second Opinion?
The Stanford Medicine Online Second Opinion program offers you easy access to our world-class doctors. It’s all done remotely and you don’t have to visit our hospital or one of our clinics for this service. You don’t even need to leave home! Visit our online second opinion page to learn more.
International Patient Referrals
Phone: +1 650-723-8561
Email: IMS@stanfordhealthcare.org
International Medical Services (IMS) at Stanford Health Care provides information, interpretation and translation services, and other supportive services for patients and families who may be seeking care from out of country.
For Physicians / Health Care Professionals
Transfer Center
Phone: 1-800-800-1551 (24 hours - 7 days a week)
Fax: 650-723-6505
Physician Helpline
Phone: 1-866-742-4811
Fax: 650-320-9443
Monday – Friday 8:30 a.m. – 5 p.m. (PST)
After hours: Call the hospital page operator at 650-723-4000 and ask for the physician on call
FAX: Fax a referral to the Cardiothoracic Surgery Department at 650-736-0901
Online Portal (PRISM)
Our online portal, known as PRISM (Physician Referral Information at Stanford Medicine), provides a streamlined platform for community physicians to send referrals, check on referral status, access medical records, and message Stanford providers.
If you have any questions about the referral process, please call us at 650-724-7500.