Endovascular Repair of Abdominal Aortic Aneurysm
(Minimally Invasive Repair of Abdominal Aortic Aneurysm; EVAR)
The aorta is the largest artery in the body. The abdominal part of the aorta is located below the diaphragm. It carries blood to the abdomen, pelvis, and legs. Sometimes, the walls of the aorta weaken and bulge in one area. This is called an abdominal aortic aneurysm (AAA). When the aneurysm reaches a certain size, it may need to be repaired. Endovascular repair of an AAA (EVAR) is done from the inside of the artery. The doctor inserts a stent graft into the area to strengthen it.
Reasons for Procedure
This procedure is often done to repair AAA when the aneurysm:
EVAR is now the preferred method to treat AAA. EVAR can result in less pain, shorter hospital stay, fewer complications, and faster recovery time compared to open surgery. However, closer follow-up over many years is needed.
Your doctor will review a list of possible complications, which may include:
Factors that may increase the risk of complications include:
Be sure to discuss these risks with your doctor before the procedure.
What to Expect
Prior to Procedure
Your doctor may:
Before the procedure:
Your doctor may use:
Description of the Procedure
You will lie on your back. You will receive medicine to ease pain and relax you. Once you are asleep and sedated, a breathing tube will be inserted into your throat and lungs. Sometimes, regional anesthesia will be used. A breathing tube will not be needed in this case.
The doctor will make small incisions in both sides of the groin. Catheters (thin tubes) will be inserted into the blood vessels and threaded up toward the aneurysm. Contrast dye will be injected through the catheters. The doctor will then guide a stent graft to the site. The graft will be placed into the weakened area and extended into both pelvic arteries. To guide each step, the doctor will use live x-ray images. Your vital signs will be monitored. Once the graft is in place, the doctor will remove the catheters. The incisions will be closed. Sterile bandages will be applied.
Immediately After Procedure
You will be taken to the intensive care unit (ICU). If you have a breathing tube, it will be removed. Your vital signs will be closely monitored.
How Long Will It Take?
About 2-3 hours
How Much Will It Hurt?
Anesthesia will prevent pain during the procedure. Your doctor will give you medicine to manage the pain during the recovery process. There is little discomfort from the groin incisions.
Average Hospital Stay
The usual length of stay is 1-2 days. Your doctor may choose to keep you longer if needed.
At the Hospital
At the hospital, you will:
When you return home, do the following to help ensure a smooth recovery:
Call Your Doctor
After you leave the hospital, contact your doctor if any of the following occurs:
Call for medical help or go to the emergency room right away if you have:
If you think you have an emergency, call for medical help right away.
American Heart Association
Society for Vascular Surgery
Canadian Cardiovascular Society
Canadian Society for Vascular Surgery
Abdominal aortic aneurysm. Society for Vascular Surgery website. Available at: http://www.vascula... . Updated January 2010. Accessed January 22, 2010.
Abdominal aortic aneurysm (AAA). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated January 22, 2010. Accessed January 27, 2010.
Abdominal aortic aneurysm repair. EBSCO Patient Education Reference Center website. Available at: http://www.ebscohost.com/pointOfCare/perc-about . Updated November 2009. Accessed January 25, 2010.
Abdominal aortic aneurism repair. Lancaster General Health website. Available at: http://www.lancastergeneral.org/content/greystone_27195.htm . Accessed January 25, 2010.
Dillon M, Cardwell C, Blair PH, Ellis P, Kee F, Harkin DW. Endovascular treatment for ruptured abdominal aortic aneurysm. Cochrane Database of Systematic Reviews website. Available at: http://www.cochrane.org/reviews/en/ab005261.html . Published January 24, 2007. Accessed January 22, 2010.
Endovascular repair of thoracic aortic aneurysms. Cleveland Clinic website. Available at: http://my.clevelan... . Updated August 2009. Accessed January 22, 2010.
Fotis T, Mitsos A, Perdikides T, et al. Regional Anesthesia versus general anesthesia in endovascular aneurism repair: the surgical nursing interventions. British Journal of Anesthetic and Recovery Nursing. 2009;10(1):11-14.
Minimally invasive surgery repairs potentially fatal aortic aneurysms. UCLA Health Systems website. Available at: http://www.uclahea... . Published September 2006. Accessed February 2, 2010.
Last reviewed March 2013 by Marcin Chwistek, MD