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Endovascular aneurysm repair (EVAR)

Endovascular aneurysm repair (EVAR) is surgery to repair an aneurysm in your aorta (the largest blood vessel in your body) to stop it from bursting. An aneurysm is a widening or bulging of the aorta.

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.

How endovascular repair for aortic aneurysm is carried out

About endovascular aneurysm repair

An abdominal aortic aneurysm is a widening of the aorta in your abdomen (tummy), often at a weak spot in the wall of your aorta. A thoracic aneurysm is a widening of the aorta in your chest. If an aneurysm bursts (ruptures), it can be fatal.

EVAR, also known as stent grafting, involves your surgeon inserting a graft that is mounted on a slender metal tube (stent). Your surgeon will feed the stent through your femoral arteries in your groin and up though the aorta to the area of the aneurysm. The graft material will bond with the arterial wall and blood will flow through the stent instead of the weakened aneurysm.

EVAR 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. Ask your doctor if it’s an option for you.

Diagnosis of aortic aneurysms

You may not have any symptoms of an aortic aneurysm, unless it’s large or growing quickly.

If you're a man over 65, you’re likely to be invited to be screened for an abdominal aortic aneurysm at your GP surgery or local hospital. The screening programme only covers abdominal aortic aneurysms, not thoracic aortic aneurysms.

Your doctor will advise you to have elective (planned surgery) if your aneurysm is:

  • larger than 5.5cm
  • expanding by more than 1cm per year
  • causing you pain or other symptoms, such as difficulty breathing

You will need to have emergency surgery if your aneurysm ruptures.

What are the alternatives to endovascular aneurysm repair?

If your aneurysm isn’t very large (less than 5.5cm) your doctor may advise you to not have any treatment but to monitor your condition.

Your surgeon may recommend that you have open surgery for an aortic aneurysm. In open surgery, your surgeon will make a cut in your chest or your abdomen to access your aorta and will insert a graft into the weak area of your aorta. This 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.

Another alternative is keyhole surgery, in which your surgeon will make two or three small cuts in your abdomen or chest and insert a tube-like telescopic camera, which will send pictures to a monitor so he or she can see the aneurysm. Your surgeon will pass specially designed surgical instruments through the other cuts and put the graft into place.

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

Preparing for your endovascular aneurysm repair

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.

EVAR usually requires a hospital stay of one to three days and it’s usually done under local anaesthesia, sometimes also under sedation. This completely blocks pain from your groin (where the stent will be inserted) and 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 endovascular aneurysm repair?

EVAR can take around two hours but this will depend on your individual circumstances, it may be shorter or longer than this. Ask your surgeon for advice.

Your surgeon will make small cuts in your groin and will pass guide wires up the femoral arteries until they reach your aorta. Your surgeon will then feed a stent – a metal tube covered with synthetic graft material – through the femoral arteries in your groin up through your aorta to the area of the aneurysm. The stent comes pre-loaded on a delivery system, which your surgeon will use to position the stent graft correctly.

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 will bond with your arterial wall and blood will flow 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.

Your surgeon will close the cut in your groin with dissolvable stitches.

What to expect afterwards

After the operation, you may be taken to an intensive treatment unit (ITU) where you will be closely monitored or you will be returned to your ward.

You may need pain relief to help with any discomfort as the anaesthetic wears off.

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 should try to have a friend or relative stay with you for the first 24 hours.

Your nurse will give you some advice about caring for your healing wounds before you go home. You may be given a date for a follow-up appointment.

Recovering from endovascular aneurysm repair

It usually takes about two weeks to make a full recovery from EVAR, but this varies between individuals, so it's important to follow your surgeon's advice.

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

What are the risks?

As with every procedure, there are some risks associated with EVAR. We haven’t included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.

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 operation. 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 your leg (deep vein thrombosis, DVT).

Specific complications of EVAR for aortic aneurysm can include:

  • 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 clots can form
  • endovascular leak (or endoleak) – blood may leak outside the stent graft and increase pressure in the aneurysm
  • kidney failure
  • a stroke
  • a wound infection – you may need treatment with antibiotics if your wound becomes infected
  • graft infection – this is very rare, but serious, and usually means that your graft will have to be removed
  • spinal cord injury – this can leave you paralysed
  • erectile dysfunction – this can affect some men if nerves in the abdomen are damaged during the operation

You will need to have regular check-ups for the rest of your life after having endovascular repair.

 

Produced by Rachael Mayfield-Blake, Bupa Heath Information Team, June 2012.

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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