Aortic aneurysm repair - endovascular
EVAR; Endovascular aneurysm repair - aorta; AAA repair - endovascular; Repair - aortic aneurysm - endovascularEndovascular abdominal aortic aneurysm (AAA) repair is surgery to repair a widened area in your aorta. This is called an aneurysm. The aorta is the large artery that carries blood from your heart to your belly, pelvis, and legs.
An aortic aneurysm is when a part of this artery becomes too large or balloons outward. It occurs due to weakness in the wall of the artery.
Aortic aneurysm
An aneurysm is an abnormal widening or ballooning of a portion of an artery due to weakness in the wall of the blood vessel. A thoracic aortic aneury...
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This procedure is done in an operating room, in the radiology department of the hospital, or in a catheterization lab. You will lie on a padded table. You may receive general anesthesia (you are asleep and pain-free) or epidural or spinal anesthesia. During the procedure, your surgeon will:
General anesthesia
General anesthesia is treatment with certain medicines that puts you into a deep sleep so you do not feel pain during surgery. After you receive the...
Read Article Now Book Mark Article- Make a small surgical cut near the groin, to find the femoral artery.
- Insert a thin, flexible tube (catheter) into the artery through the cut.
- Insert a stent (a metal coil) and a man-made (synthetic) graft along the catheter.
- Then use a dye to define the extent of the aneurysm.
- Use x-rays to guide the stent graft up into your aorta, to where the aneurysm is located.
- Next open the stent using a spring-like mechanism and attach it to the walls of the aorta. Your aneurysm will eventually shrink around it.
- Use x-rays and dye again to make sure the graft is in the right place and your aneurysm is not bleeding inside your body.
- Remove the catheter and close the surgical cut where the catheter was inserted.
Why the Procedure Is Performed
Endovascular aneurysm repair (EVAR) is done because your aneurysm is very large, growing quickly, or is leaking or bleeding.
You may have an AAA that is not causing any symptoms or problems. Your health care provider may have found this problem when you had an ultrasound or CT scan for another reason. There is a risk that this aneurysm may burst (rupture) if you do not have surgery to repair it. However, surgery to repair the aneurysm may also be risky. In such cases, EVAR is an option.
Ultrasound
Ultrasound uses high-frequency sound waves to make images of organs and structures inside the body.
Read Article Now Book Mark ArticleCT scan
A computed tomography (CT) scan is an imaging method that uses x-rays to create pictures of cross-sections of the body. Related tests include:Abdomin...
Read Article Now Book Mark ArticleYou and your provider must decide whether the risk of having this surgery is smaller than the risk for rupture if you do not have surgery to repair the problem. The provider is more likely to recommend that you have surgery if the aneurysm is:
- Larger (about 2 inches or 5 centimeters)
- Growing more quickly (a little less than 1/4 inch or 0.5 centimeter over the last 6 to 12 months)
EVAR has a lower risk of developing complications compared to open surgery. Your provider is more likely to suggest this type of repair if you have other serious medical problems or are an older person.
Risks
Risks of any surgery are:
-
Blood clots in the legs that may travel to the lungs
Blood clots
Blood clots are clumps that occur when blood hardens from a liquid to a solid. A blood clot that forms inside one of your veins or arteries is calle...
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Breathing problems
Breathing problems
Breathing difficulty may involve:Difficult breathing Uncomfortable breathingFeeling like you are not getting enough air
Read Article Now Book Mark Article - Infection, including in the lungs, urinary tract, and belly
-
Heart attack or stroke
Heart attack
Most heart attacks are caused by a blood clot that blocks one of the coronary arteries. The coronary arteries bring blood and oxygen to the heart. ...
Read Article Now Book Mark ArticleStroke
A stroke occurs when blood flow to a part of the brain stops. A stroke is sometimes called a "brain attack. " If blood flow is cut off for longer th...
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Risks of this surgery are:
- Bleeding around the graft that needs more surgery
- Bleeding before or after procedure
- Blockage of the stent
- Damage to a nerve, causing weakness, pain, or numbness in the leg
-
Kidney failure
Kidney failure
An erection problem occurs when a man cannot get or keep an erection that is firm enough for intercourse. You may not be able to get an erection at ...
Read Article Now Book Mark Article - Poor blood supply to your legs, your kidneys, or other organs
- Problems getting or keeping an erection
- Surgery is not successful and you need an open surgery
- The stent graft slips
- The graft leaks and requires open surgery
- Death
Before the Procedure
Your provider will examine you and order tests before you have surgery.
Always tell your provider what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.
If you are a smoker, you should stop. Your provider can help. Here are other things you will need to do before your surgery:
- About two weeks before your surgery, you will visit your provider to make sure any medical problems, such as diabetes, high blood pressure, and heart or lung problems, are well treated.
Diabetes
Diabetes is a long-term (chronic) disease in which the body cannot regulate the amount of sugar in the blood.
Read Article Now Book Mark ArticleHigh blood pressure
Blood pressure is a measurement of the force exerted against the walls of your arteries as your heart pumps blood to your body. Hypertension is the ...
Read Article Now Book Mark Article - You also may be asked to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), clopidogrel (Plavix), warfarin (Coumadin), and naproxen (Aleve, Naprosyn).
- Ask which drugs you should still take on the day of your surgery.
- Always tell your provider if you get a cold, flu, fever, herpes breakout, or other illness before your surgery.
The evening before your surgery:
- DO NOT drink anything after midnight, including water.
On the day of your surgery:
- Take any medicines your doctor told you to take with a small sip of water.
- You will be told when to arrive at the hospital.
After the Procedure
Most people stay in the hospital for a few days after this surgery, depending on the type of procedure they had. Most often, the recovery from this procedure is faster and with less pain than with open surgery. Also, you will most likely be able to go home sooner.
During a hospital stay, you may:
- Be in the intensive care unit (ICU), where you will be watched very closely at first
- Have a urinary catheter
Urinary catheter
A urinary catheter is a tube placed in the body to drain and collect urine from the bladder.
Read Article Now Book Mark Article - Be given medicines to thin your blood
- Be encouraged to sit on the side of your bed and then walk
- Wear special stockings to prevent blood clots in your legs
- Receive pain medicine into your veins or into the space that surrounds your spinal cord (epidural)
Outlook (Prognosis)
Recovery after endovascular repair is quick in most cases.
You will need to be watched and checked regularly to make sure your repaired aortic aneurysm is not leaking blood.
References
Braverman AC, Schemerhorn M. Diseases of the aorta. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 42.
Brinster CJ, Sternbergh WC. Endovascular aneurysm repair techniques. In: Sidawy AN, Perler BA, eds. Rutherford's Vascular Surgery and Endovascular Therapy. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 74.
Fanelli F, Falcone GM. Endovascular aortic repair. In: Mauro MA, Murphy KP, Thomson KR, Venbrux AC, Morgan RA, eds. Image-Guided Interventions. 3rd ed. Philadelphia, PA: Elsevier; 2021:chap 20.
Review Date: 10/18/2022
Reviewed By: Deepak Sudheendra, MD, MHCI, RPVI, FSIR, Founder and CEO, 360 Vascular Institute, with an expertise in Vascular Interventional Radiology & Surgical Critical Care, Columbus, OH. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.