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What is Endovascular Aortic Repair (EVAR)?

Endovascular aortic repair (EVAR) is a minimally invasive surgical procedure to treat patients suffering from abdominal aortic aneurysm.

An aneurysm is a weak and bulged section in the aorta wall. Aortic aneurysm is a condition characterized by an abnormal ballooning or bulging of an area of the aorta due to weakness in the wall of the blood vessel. The aorta is the main blood vessel that carries oxygenated blood from the heart to the different parts of the body. An aneurysm can develop anywhere along the course of the aorta. Aneurysms that occur in the part of the aorta that passes through the ABDOMEN are called ABDOMINAL aortic aneurysms. If left untreated, the abdominal aortic aneurysm can burst open, leading to a large amount of internal bleeding, resulting in often life-threatening complications.

The term endovascular refers to “inside a blood vessel.” abdominal endovascular aortic repair involves placing a stent-graft (a metal tube covered in fabric) into the weakened area of the artery through a blood vessel in the groin to reinforce the aneurysm. This helps to prevent the aneurysm from bursting.

Indications for Endovascular Aortic Repair (EVAR)

Your surgeon may recommend endovascular aortic repair surgery under the following conditions:

  • You are not a candidate for traditional open repair
  • The aneurysm or bulge is increasing or growing in size (5 cm or more)
  • To prevent the aneurysm from rupturing, which can cause death
  • If the aneurysm is causing symptoms such as pain, abnormal bleeding, and high blood pressure
  • Damage to the aorta from injury or trauma
  • Focal penetrating ulcer in the abdominal aorta
  • Continue taking your blood pressure medication on the day of surgery.
  • You may be asked to stop certain blood thinners prior to surgery including coumadin, Eliquis, Xarelto, Aspirin, Plavix.
  • Aortic dissection or separation of the 3 layers of the aorta

Preparation for Endovascular Aortic Repair (EVAR)

Preoperative preparation for endovascular aortic repair may involve the following steps:

  • A review of your medical history and a physical examination to check for any medical issues that need to be addressed prior to surgery.
  • Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could compromise the safety of the procedure.
  • You will be asked if you have allergies to medications, anesthesia, or latex.
  • You should inform your doctor of any medications or supplements you are taking or any conditions you have such as heart or lung disease.
  • You may be asked to stop taking blood-thinners, anti-inflammatories, or other supplements for a week or two.
  • You should refrain from alcohol and tobacco at least a few days prior to surgery and several weeks after surgery.
  • You should not consume any solids or liquids at least 8 hours prior to surgery.
  • Arrange for someone to drive you home as you will not be alert enough to drive yourself after surgery.
  • Informed consent will be obtained from you after the surgery has been explained in detail.

Procedure for Endovascular Aortic Repair (EVAR)

In general, the minimally invasive endovascular aortic repair surgery involves the following steps:

  • You will be administered general or local anesthesia by your anesthesiologist.
  • You will lie on your back on the operating table and the groin area is shaved and cleaned with an antiseptic solution.
  • A small surgical cut is made in the groin area to access the blood vessel (femoral artery).
  • A small catheter (thin tube) attached with a stent graft to its end is inserted into the femoral artery in the groin.
  • Using X-ray guidance, your surgeon will guide the catheter, attached with the stent graft, through the femoral artery to the affected area of your aorta.
  • A contrast medium (dye) is injected into the abdominal aorta so that the area is clearly visible under imaging for utmost accuracy.
  • The stent-graft is delivered in a collapsed state through the catheter so that it is narrow and can fit through your blood vessel.
  • Once the stent-graft is in place, it is expanded to fit against the walls of the aorta on either side of the aneurysm. Consequently, the blood flows through the graft, avoiding the aneurysm that normally shrinks over time as the blood supply is diverted away from the aneurysm.
  • Finally, your physician will remove the catheter, and the site of the incision is closed with a small bandage or a plug.

Postoperative Care and Recovery

Following the procedure, you will be transferred to the recovery room where your nurse will monitor your vital signs. You may need to stay in the hospital for a day or two. You may experience pain or discomfort for which your physician will prescribe medications. You will be given blood-thinning medications to prevent blood clot formation. You can resume all your normal activities within a month. Refrain from strenuous activities, lifting heavy weights, and driving for a defined period. A gradual increase in activities is recommended. Instructions on incision site care and bathing will be provided to keep the wound clean and dry. Follow-up visits may be ordered, during which a CT scan may be necessary to ensure optimal functioning of the graft.

Benefits of Endovascular Aortic Repair (EVAR)

Some of the benefits of endovascular aortic repair over traditional open surgery include:

  • Shorter hospital stay
  • Faster recovery
  • Minimal muscle trauma
  • Smaller to no visible scar
  • Less bleeding
  • Decreased risk of infection
  • Less postoperative pain
  • Quicker return to normal daily routines

Risks and Complications

endovascular aortic repair is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:

  • Infection
  • Bleeding
  • Blood clots
  • Allergic/anesthetic reactions
  • Damage to nearby tissues or organs
  • Stent migration
  • Endoleak (leakage of blood from the graft)
  • Injury to kidneys
  • Weakness in the legs
  • Stroke
  • Tissue necrosis (death of tissue)