EVAR (Endovascular Aneurysm Repair) is a modern, minimally invasive approach to treating aortic aneurysms. This technique has transformed the repair of aortic aneurysms, offering patients an alternative to traditional open surgery. By reinforcing the weakened section of the aorta, EVAR reduces the life-threatening risk associated with the condition. The procedure is less traumatic, leading to faster recovery times and less strain on the body.
Defining EVAR and Treating Aortic Aneurysms
EVAR addresses aneurysms in the aorta, the main blood vessel carrying oxygenated blood from the heart. An aneurysm forms when a section of the aortic wall weakens, causing the vessel to balloon outward due to blood pressure.
The most frequent location for this is the lower part of the aorta, known as an Abdominal Aortic Aneurysm (AAA). While an AAA is defined as an aortic diameter greater than 3 centimeters, repair is typically considered when the diameter reaches 5.5 centimeters or more. If the aneurysm grows too large, the weakened wall can rupture, causing massive internal bleeding and a low chance of survival.
The goal of treatment is to reinforce the vessel and prevent rupture. Traditionally, this involved open surgery requiring a large abdominal incision to replace the damaged section with a synthetic graft, resulting in a complex operation and long recovery. EVAR is a keyhole surgery that achieves reinforcement from within the blood vessel.
This endovascular approach avoids a major abdominal incision, significantly reducing trauma. The repair is conducted entirely inside the artery using specialized, guided tools. This internal reinforcement defines the advantage of the EVAR technique.
The Step-by-Step EVAR Procedure
The EVAR procedure begins with the patient under anesthesia, often general. The surgeon accesses the arterial system through small incisions, typically in the groin over the femoral arteries. These small puncture sites are sufficient for the entire repair to take place.
A thin, flexible catheter is inserted into the femoral artery and guided toward the aneurysm site in the aorta. The surgeon uses fluoroscopy (real-time X-ray imaging with contrast dye) to visualize the catheter’s path and ensure precise navigation.
The catheter delivers the specialized repair device, known as a stent-graft. This device is a fabric tube supported by a flexible metal mesh frame, initially compressed to fit inside the delivery catheter.
The stent-graft is deployed and expanded to line the entire length of the aneurysm. The metal frame anchors the device securely against the healthy aortic walls above and below the aneurysm. This creates a new, stable pathway for blood flow, diverting pressure away from the weakened wall.
Deployment seals the aneurysm sac off from high-pressure circulation, allowing the sac to shrink or stabilize. After confirming placement, the surgeon removes the catheter and closes the small incisions. This establishes a reinforced channel for blood to pass safely through the aorta.
Post-Procedure Recovery and Long-Term Follow-Up
A primary benefit of the minimally invasive EVAR procedure is the significantly shorter recovery time compared to open surgery. Patients typically stay in the hospital for one to three days, often returning home the day after the procedure. Immediate recovery involves observation to ensure the stent-graft is functioning and managing mild pain.
Upon discharge, patients must refrain from heavy lifting and strenuous activity for four to six weeks. Light activities, such as walking, are encouraged quickly to aid circulation and recovery. Patients generally resume most routine activities within about a month.
The long-term success of EVAR relies on consistent surveillance, requiring regular follow-up appointments and periodic imaging studies like CT scans or ultrasounds. This monitoring is mandatory because the aneurysm sac remains in the body, and the graft must be checked to ensure it remains stable and functional.
Surveillance detects potential complications, primarily endoleaks or graft migration. An endoleak occurs when blood flows back into the sealed aneurysm sac, which can re-pressurize the wall and potentially lead to rupture. Regular imaging ensures that if a leak or movement is detected, a secondary intervention can maintain the repair’s integrity.