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Endovascular aneurysm repair (EVAR)

This factsheet is for people who are having endovascular repair for an aortic aneurysm, or who would like information about it.

Endovascular aneurysm repair (EVAR) is surgery to repair an aneurysm in the aorta (the largest blood vessel in your body) to stop it from bursting. An aneurysm is a widening or bulging of the aorta. EVAR is also known as stent grafting, as it involves inserting a graft mounted on slender metal tubes (stents).

You will meet the surgeon carrying out your procedure to discuss your care. It may differ from what is described here, as it will be designed to meet your individual needs. Details of the procedure may also vary from country to country.

Click on the tabs below for more information about EVAR. 

Published by Bupa's Health Information Team, July 2010.

How keyhole abdominal aortic aneurysm surgery is carried out

About

About

About aortic aneurysms


The aorta is usually 2 to 3cm in diameter. A weak spot in the aorta can cause it to bulge outwards (this is called an aneurysm). If the bulge occurs in the aorta as it goes through your chest, it's called a thoracic aortic aneurysm. If it occurs in the aorta as it goes through your abdomen, it's called an abdominal aortic aneurysm (AAA). AAAs are more common than thoracic aneurysms.

The chance of an aneurysm rupturing depends on its size. If your aneurysm is greater than 5.5cm wide, the chances of rupture are high and the risk increases with increasing size. If an aneurysm bursts (ruptures), it can be fatal.

Diagnosis

Diagnosis

Diagnosis of aortic aneurysms


Aortic aneurysms often don't have any symptoms, unless they are large or are growing quickly. A doctor may only suspect you have an aortic aneurysm following a routine examination.
Screening for an abdominal aortic aneurysm may be available in some countries.

Your doctor will recommend surgery if your aneurysm is more than 5.5cm in diameter or causing symptoms.
 

What are the alternatives?


Endovascular repair isn't suitable for everyone. It depends on several factors, including the shape of your aneurysm, how near it is to other blood vessels and whether the arteries in your groin are large enough for the stent graft and the delivery device to be inserted.

Open surgery for aortic aneurysm (where a surgeon makes a cut in your chest or abdomen) has been the standard procedure for many years. You may be advised to have this, rather than endovascular repair, which is a relatively new procedure.

Your surgeon will advise you which procedure is best for you.

Operation

Operation

Preparing for your operation


Your surgeon will explain how to prepare for your operation. For example, if you smoke you will be asked to stop, as smoking increases your risk of getting a chest and wound infection, which can slow your recovery.

The operation may be done under local anaesthesia. This completely blocks feeling in your groin (where the stent will be inserted) but you will stay awake during the operation. Alternatively, you can have a general anaesthetic and will be asleep during the operation. If you're having a general anaesthetic, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it's important to follow your anaesthetist's advice.

Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.
 

What happens during EVAR


A stent – a metal tube that is covered with synthetic graft material – is fed through the femoral arteries in your groin up though the aorta to the area of the aneurysm. The stent comes pre-loaded on a delivery system, which will be used to position the stent graft correctly.

Your surgeon will make small cuts in your groin and will pass guide wires up the femoral arteries until they reach the aorta. Your surgeon will use X-ray images to guide the wires, confirm the position of your aneurysm and put the stent graft in place. The graft material bonds with the arterial wall and the blood flows through the stent instead of the weakened aneurysm.

You will usually have a CT angiogram to check your blood is flowing correctly through the stent.

The cut in your groin is closed with dissolvable stitches.

Recovery and risks

Recovery and risks

What to expect afterwards


After your operation, you may be taken to an intensive care unit (ICU; sometimes known as a critical care unit), where you will be closely monitored for around 24 hours. You may have a tube in your mouth, which passes into your windpipe (trachea) and is connected to a ventilator (a machine to help you breathe). This will be removed once you’re alert and can breathe by yourself.

You will be given painkillers to help with any discomfort as the anaesthetic wears off.

You can expect to stay in hospital for about three days.

The length of time your stitches will take to dissolve depends on what type you have. However, for this procedure they usually disappear within a couple of months.

When you're ready to go home, you will need to arrange for someone to drive you home. You may be given a date for a follow-up appointment.

What are the risks?


Endovascular aneurysm repair is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications.

Side-effects


Side-effects are the unwanted but mostly temporary effects you may get after having the procedure.

After EVAR, your groin area (where the stent was inserted) may feel sore for a few days.

Complications


Complications are when problems occur during or after the procedure. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).
Other complications of EVAR are uncommon but can include:

  • wound infection – you may need treatment with antibiotics
  • graft migration – the graft may move from its position
  • wire fracture or fabric tear – the wires or fabric of the stent graft may break
  • limb thrombosis – one of the limbs of the stent graft may kink or block and cause swelling
  • endovascular leak (or endoleak) – blood may leak outside the stent graft and increase pressure in the aneurysm
  • kidney damage – depending on the location of the aneurysm, your kidney function may be affected
  • graft infection – this is very rare, but serious, and usually means that your graft will have to be removed
You will need to have regular check-ups for the rest of your life after having endovascular repair.

The exact risks are specific to you and differ for every person, so we have not included statistics here. Ask your surgeon to explain how these risks apply to you.

Sources

Sources

This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. Photos and videos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

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