TBE Frequently Asked Questions
What is the aorta, and what does it do?
The aorta is the largest artery in your body. It carries oxygen-rich blood away from your heart and distributes it through smaller branching arteries to your brain, arms, organs, and the rest of your body. The thoracic aorta is the portion that travels through your chest.
What is thoracic branched endoprosthesis (TBE)?
Thoracic branched endoprosthesis, or TBE, is a minimally invasive treatment for certain conditions affecting the descending thoracic aorta. During the procedure, doctors guide a fabric-covered metal stent graft through an artery—usually from the groin—and place it inside the aorta to reinforce the affected area and create a new path for blood flow.
Unlike a standard thoracic stent graft, the TBE device includes a separate branch that helps preserve blood flow to the left subclavian artery, an important artery that supplies blood to the left arm and portions of the brain.
How is a branched stent graft different from a standard stent graft?
A standard thoracic stent graft is essentially a fabric-covered tube that lines the inside of the aorta. When the affected area is close to the left subclavian artery, placing a standard graft may cover that artery. A separate surgical bypass or rerouting procedure may then be needed to maintain blood flow.
A branched stent graft has a built-in opening and side branch that connects to the left subclavian artery. This allows the graft to treat the nearby aortic disease while continuing to supply blood to the artery, which may eliminate the need for a separate open surgical bypass.
What conditions might be treated with TBE?
TBE may be considered for select conditions affecting the descending thoracic aorta near the left subclavian artery. These may include:
- A thoracic aortic aneurysm, which is a weakened, enlarged, or bulging area of the aorta
- An aortic dissection, which occurs when a tear allows blood to flow between layers of the aortic wall
- A traumatic injury or partial tear of the aorta
- Certain other isolated aortic lesions, such as a penetrating aortic ulcer
Whether TBE is appropriate depends on the condition’s location and severity, the patient’s anatomy, and other medical considerations. The FDA-approved indication is specifically for lesions of the descending thoracic aorta when maintaining blood flow to the left subclavian artery is necessary and the patient is at high risk for a surgical debranching procedure.
How do I know whether I may be a candidate for TBE?
Determining whether you are a candidate requires a detailed evaluation by our experienced TBE surgeons. Our team will consider:
- The type, size, and location of the aortic condition
- Whether the affected area is close to the left subclavian artery
- The size and shape of your aorta and branching arteries
- Whether your blood vessels can safely accommodate the delivery system
- Your age, overall health, prior procedures, and other medical conditions
- Your ability to complete the imaging and follow-up required after treatment
A CT angiogram is commonly used to obtain the detailed measurements needed for treatment planning. Not everyone is a candidate for TBE, and another endovascular procedure, open surgery, medical management, or continued monitoring may be more appropriate.
How is TBE different from open surgery or other aortic procedures?
Open aortic surgery generally requires a larger incision in the chest and replacement of the affected section of the aorta with a graft that is sewn into place. TBE is performed from inside the blood vessels using catheters and X-ray guidance, usually through a small incision or puncture near the groin.
Because TBE is less invasive, it may offer potential advantages such as smaller incisions, less blood loss, less discomfort, and a shorter hospital stay and recovery than open surgery. However, open surgery may still be the safest or most durable option for some patients, particularly when their anatomy or type of aortic disease is not suitable for an endovascular repair.
Will I still need another surgery or bypass procedure?
One potential benefit of TBE is that its side branch can maintain blood flow to the left subclavian artery without a separate open bypass or artery-rerouting procedure. However, this cannot be guaranteed.
Depending on your anatomy and the extent of your aortic disease, you may still need an additional stent graft, a bypass, a staged procedure, or open surgery. Additional treatment may also become necessary later if imaging shows a leak around the graft, movement or narrowing of the device, continued enlargement of the aorta, progression of the disease, or another complication.
What does recovery and follow-up look like after the TBE procedure?
Recovery varies based on your overall health, the condition being treated, and whether any additional procedures are performed. After the procedure, your care team will monitor your blood pressure, circulation, kidney function, neurologic function, and the access site used to place the device. Your surgeon will tell you when it is safe to return to driving, work, exercise, lifting, and other activities.
TBE requires long-term—and generally lifelong—follow-up, even when you feel well. Follow-up typically includes a physical examination and CT or other imaging to confirm that the graft remains in the correct position and the treated area is stable. Follow-up visits commonly occur at one month, six months, and annually thereafter, but the exact schedule will be personalized by your doctors.
Why do a cardiothoracic surgeon and a vascular surgeon work together?
The aorta connects the heart and the body’s vascular system, so complex aortic conditions often cross the traditional boundaries between cardiac and vascular surgery. A cardiothoracic surgeon brings specialized knowledge of the heart, chest, and open aortic surgery, while a vascular surgeon brings expertise in blood vessels, catheter-based procedures, and endovascular repair.
At Community Memorial, Ryan Vela, MD, a board-certified cardiothoracic surgeon, and David Blitzer, MD, a board-certified vascular surgeon, work together to review each patient’s imaging, anatomy, overall health, prior procedures, and treatment options. This collaborative approach allows the team to develop an individualized plan and to prepare for both endovascular and surgical needs.
How can I request an evaluation for TBE?
Start by speaking with your primary care provider, cardiologist, or another member of your care team. Share our TBE Fact Sheet, and ask for a referral for Ryan Vela, MD, or David Blitzer, MD. You may also call Dr. Vela or Dr. Blitzer for more information.
