What is endovascular aneurysm repair?
Endovascular aneurysm repair (EVAR) is a minimally invasive way to repair an aortic aneurysm. It is also called endovascular stent grafting. The procedure is done using a long, thin tube called a catheter to put a fabric-covered stent (stent graft) in place. The stent reinforces the area of the blood vessel and seals off the aneurysm. This technique is called a TEVAR when it is used to repair a thoracic aortic aneurysm, and a FEVAR when it is a fenestrated endovascular aneurysm repair. A FEVAR is used to repair aneurysms that are in the arteries that carry blood to your kidneys and intestines.
Who can have EVAR?
You may be able to have EVAR instead of traditional, open surgery if your aneurysm is bigger than 5.5 cm (if you are a man) or 5.0 cm (if you are a woman) and your anatomy is right for EVAR. Your doctor will also consider:
- Whether the aneurysm is causing pain in your back or abdomen.
- The size and shape of the aneurysm and the blood vessels above and below it.
- How fast the aneurysm is growing.
- Whether you have an aortic dissection or blockages in the arteries that carry blood to your legs.
- Your overall health.
How do I prepare for EVAR?
Your doctor will give you specific instructions to follow before the procedure. You may need to have tests, make changes to your medications and follow other steps to get ready for EVAR. Please make sure you understand all of the information, and let your doctor know if you have any questions.
What happens during EVAR?
A vascular surgeon will perform the procedure in an operating room. You will either get medication to make you sleepy and local anesthesia or general anesthesia (be completely asleep). The procedure takes about two to three hours.
Your surgeon will likely only make small incisions in your groin area, about the width of a fingernail. With the help of an X-ray, your surgeon will guide catheters through the incisions into your blood vessels to the aneurysm, and the stent graft is put in place. The stent graft pops open and stays in place, acting like a scaffold. It adds strength to the weakened area of your aorta and lets blood flow through without pushing on the aneurysm. The catheters are then removed, and the incisions are closed.
What happens after EVAR?
You will stay in the hospital overnight. We will keep a close eye on your condition and talk to you before you go home about medications you may need to take, instructions to follow (discharge instructions) and what to do if you have a problem or question. Please make sure you understand all of this information before you go home.
You will be tired for a few weeks. You may have a low-grade fever (100◦ - 101◦ F). This is caused by inflammation as blood stops flowing through the aneurysm. You may feel like you have the flu, but the symptoms will disappear in several days.
Please follow your discharge instructions. But, in general:
- Do not drive until your doctor says it is OK. You will need to wait about one to two weeks after your procedure and have stopped taking pain medication before you can drive again.
- Keep your incisions clean. You can take a shower and wash the incisions starting two days after the procedure.
- Wash your hands before you touch your incisions.
- Do not lift more than 8 to 10 pounds for four weeks after the procedure.
You should be fully recovered and able to return to your normal activities in about two weeks.
What are the risks of EVAR?
There is a risk of problems with all medical procedures. Your healthcare team will do everything possible to reduce your risks. Your surgeon will talk to you about your individual risks before the procedure. Some risks of having EVAR include:
- The graft not sealing off the aneurysm.
- A clot from the aneurysm could break off and cause damage to your brain, intestines, kidneys or legs.
- Infection at your incision sites or in your aorta.
- Rare complications, such as rupture of the aneurysm, kidney injury or paralysis.
What type of follow-up care will I need after EVAR?
Your doctor will let you know how often and the type of follow-up visits you need after EVAR. In general, you will need a CT scan one month after surgery to see how well the EVAR worked. Your doctor will also measure the blood flow to your legs and order X-rays to use as a comparison over time. You will likely then need to have a visit six months to one year after the EVAR, and once a year or every other year after that. A small number of patients (1% - 2%) need another procedure to ensure the success of the repair over time.
