Endovascular Abdominal Aneurysm Repair

June 1, 2023

Endovascular Abdominal Aneurysm Repair (EVAR) is a minimally invasive surgical procedure used to treat abdominal aortic aneurysms (AAA). It involves the placement of a stent graft inside the aorta to reinforce the weakened artery wall and prevent the aneurysm from rupturing.

 

Causes

Many factors can contribute to aortic wall damage causing an aortic aneurysm, such as:

  • High blood pressure
  • Smoking
  • Aging
  • Certain genetic conditions (such as Marfan’s syndrome)
  • Atherosclerosis
  • Certain infections

 

Treatments

EVAR is primarily used to treat abdominal aortic aneurysms, which are bulges or enlargements in the abdominal aorta.

 

Before the Procedure

Before the EVAR procedure, the patient will undergo a thorough evaluation, including medical history review, physical examination, and imaging tests (such as computed tomography angiography) to determine the size, location, and suitability of the aneurysm for endovascular repair.

 

During the Procedure

  • Anesthesia: EVAR is typically performed under general anesthesia, although local anesthesia with sedation may be used in some cases.
  • Access and Catheterization: The surgeon makes small incisions in the groin and inserts catheters into the femoral arteries. These catheters are used to guide the stent graft to the site of the aneurysm.
  • Stent Graft Placement: The stent graft, a fabric tube supported by a metal mesh, is carefully guided through the catheters and positioned within the aneurysm. The graft is then expanded, providing a reinforced channel for blood flow and excluding the aneurysm.
  • Closure and Recovery: After the stent graft is successfully placed, the catheters are removed, the incisions are closed, and a bandage is placed on the wound.

 

After the Procedure

The patient is closely monitored in a recovery area or intensive care unit (ICU) before being transferred to a regular hospital room.

 

Advantages

  • Minimally Invasive: EVAR is a minimally invasive procedure compared to traditional open surgery, resulting in smaller incisions, reduced blood loss, and faster recovery.
  • Shorter Hospital Stay: Patients undergoing EVAR typically have a shorter hospital stay compared to open surgery, allowing for a quicker return to daily activities.
  • Reduced Risk of Complications: EVAR is associated with a lower risk of post-operative complications, such as infections and wound healing issues.

 

Risks and Complications

While EVAR is generally considered safe, there are some potential risks and complications, including:

  • Infection
  • Reduced blood flow to the legs, intestines, or kidneys
  • A graft that moves or bends
  • Bleeding at the insertion site
  • Pressure in the abdomen, causing potential organ damage (abdominal compartment syndrome)

 

Typical Recovery Time

The recovery time after EVAR can vary depending on the individual patient’s health and the complexity of the procedure. In general, patients can expect a shorter hospital stay compared to open surgery, with most individuals discharged within a few days. However, it’s important to note that the full recovery may take several weeks to months.

 

Results and Post-Procedure Care

EVAR has shown promising results in reducing the risk of aneurysm rupture and improving overall outcomes. Post-procedure care may involve regular follow-up appointments with the healthcare team to monitor the stent graft’s position and function, imaging tests to assess aneurysm size, and blood pressure management. Adopting a heart-healthy lifestyle, including regular exercise, a balanced diet, and smoking cessation, is crucial for long-term success.

 

If you have specific concerns about a procedure or your health, please consult a physician.