Endovascular Aneurysm Repair (EVAR)

When an aortic aneurysm reaches a dangerous size, it may be possible to repair it with minimally invasive techniques called Endovascular Aneurysm Repair (EVAR).

EVAR basically means repairing the aneurysm from within and is performed with 2 small cuts in the groin rather than a midline abdominal cut. EVAR reduces the risk of aneurysm repair provided the patient and the aneurysm are suitable. Unfortunately, not all patients are suitable, and attempting EVAR in these cases may be more dangerous.

There is usually some pre-operative medical workup required, as well as specialised CT scans and possibly an angiogram. The procedure requires careful planning in co-operation with the company who manufacture the stent grafts which are placed during the repair. Depending on the complexity of the case, this may take 6-8 weeks to plan and manufacture to ensure an exact fit to your aneurysm. The device is usually in three parts – one for the main aorta and extensions into each of the arteries in the legs.

The operation is performed under general anaesthetic with intra-operative monitoring for maximum safety. These may include an arterial pressure monitor in the artery at the wrist, a central line venous catheter and a urinary catheter. These are placed after anaesthetic for maximum comfort.

The operation is usually performed through two incisions about 5cm in length – one in each groin. Through these incisions, the femoral arteries are carefully dissected out. Through these arteries, a small angiogram catheter is placed and imaging of the aorta and the aneurysm is performed. Blood thinner is given. The main section is then introduced, positioned, checked and deployed in the main aorta, achieving a seal above the aneurysm. Through each of the legs, the extensions are docked with the main body and deployed in the arteries heading to the legs, thus excluding the aneurysm from the blood pressure and rendering it safe. The arteries in the groin are then repaired and the wounds carefully closed in layers.

Occasionally you may need to be treated in intensive care after the EVAR repair, but commonly the patient is well enough to go straight to the ward. Usually patients are mobile the next day and discharged in 5 days or less.

There are several complications which can occur during and after aneurysm repair including bleeding, bowel dysfunction, limb dysfunction, renal dysfunction, heart strain and heart attack, lung problems including pneumonia and others. In worst cases, death can occur, though 98% patients survive.

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