EVAR (Endovascular Aneurysm Repair): A Minimally Invasive Solution for Abdominal Aortic Aneurysms
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What Is EVAR?
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When Is EVAR Indicated?
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How Is the EVAR Procedure Performed?
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What Is TEVAR (Thoracic Endovascular Aneurysm Repair)?
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Frequently Asked Questions
Aortic aneurysms are vascular abnormalities that often progress silently and, if ruptured, can lead to life-threatening internal bleeding. Most aneurysms are asymptomatic and are only detected incidentally during imaging for unrelated issues or routine screenings.
Thanks to advances in modern medicine, safer and less invasive approaches with faster recovery times are now prioritized in treatment. One such technique is EVAR (Endovascular Aneurysm Repair)—a minimally invasive procedure for repairing abdominal aortic aneurysms.
What Is EVAR?
EVAR is a minimally invasive endovascular technique used to treat abdominal aortic aneurysms (AAA) without the need for open surgery. During this procedure, a stent graft is inserted into the affected segment of the aorta to reinforce the weakened vessel wall and redirect blood flow through a stable channel, preventing further aneurysm expansion or rupture.
Unlike open surgery, EVAR is performed through small incisions in the groin using the femoral arteries, offering reduced surgical trauma, quicker recovery, and lower complication risks - especially in appropriately selected patients.
When Is EVAR Indicated?
EVAR is commonly recommended for abdominal aortic aneurysms larger than 5.5 cm in diameter. It may also be considered in smaller aneurysms if they are rapidly growing or deemed at risk of rupture.
Ideal Candidates for EVAR:
- Aneurysms exceeding critical size thresholds
- Rapidly expanding aneurysms
- Patients with cardiac, pulmonary, or renal comorbidities (high-risk for open surgery)
- Individuals aged 65 and older
- Patients with low tolerance for major surgery
- Those preferring minimally invasive treatment options
Final eligibility for EVAR is determined by a vascular surgeon after comprehensive evaluation.
How Is the EVAR Procedure Performed?
Diagnosis and Planning
EVAR begins with CT angiography, which helps determine the aneurysm’s size, shape, and relation to nearby arteries. If suitable, an endovascular repair is planned.
Step-by-Step EVAR Procedure:
- Access Site: A small incision is made in the groin to access the femoral artery.
- Guidewire and Delivery System: A catheter carrying the stent graft is advanced into the abdominal aorta.
- Deployment of Stent Graft: Under imaging guidance, the stent graft is positioned over the aneurysmal segment and deployed to line the aortic wall.
- Redirected Blood Flow: Once placed, the graft channels blood through its interior, isolating the aneurysm sac from pressure.
- Closure: Catheters are removed, and access sites are closed. Most procedures are completed within 1–2 hours, and patients may begin walking the same day.
Preoperative Preparation for EVAR
- Preparation is critical to ensure safety and success.
Diagnostic Workup:
- CT Angiography to assess aneurysm characteristics
- Echocardiography & Cardiac Tests to evaluate heart function
- Renal Function Tests to assess contrast agent tolerance
- Coagulation Profile to evaluate bleeding risk
Patient Education:
- Patients are informed about the procedure, stent graft design, potential risks, lifespan of the graft, and follow-up requirements.
Stent Graft Selection:
- Grafts are customized based on individual anatomy. Parameters include diameter, length, bifurcation, and flexibility. Custom-made grafts may be used if needed.
Post-EVAR Recovery and Monitoring
- While EVAR is minimally invasive, long-term surveillance is crucial for sustained success.
Hospital Stay:
- Patients are observed for 24–48 hours
- Vital signs and wound sites are closely monitored
- Early ambulation is encouraged to reduce blood clot risk
Discharge and Early Recovery:
- Most patients are discharged by Day 3
- Light activity is advised for the first week
- Avoid heavy lifting and ensure proper hydration
- Adherence to prescribed blood thinners is essential
Long-Term Follow-Up Protocol:
- 1st Month: Contrast-enhanced CT to check graft position and for endoleaks
- 6th & 12th Month: Repeat imaging
- Annually Thereafter: Lifelong monitoring recommended
Surveillance aims to detect potential complications like endoleak, stent migration, or graft blockage early.
What Is TEVAR (Thoracic Endovascular Aneurysm Repair)?
TEVAR is a similar endovascular approach, but used for thoracic aortic aneurysms. These aneurysms form in the chest and may result from trauma, genetic disorders, or uncontrolled hypertension. Like EVAR, TEVAR uses a stent graft to reinforce the weakened segment and prevent rupture.
EVAR vs. TEVAR: Key Differences
| Criteria | EVAR | TEVAR |
| Criteria | EVAR | TEVAR |
|---|---|---|
| Target Region | Abdominal aorta | Thoracic aorta |
| Stent Graft Design | Bifurcated graft (extends to iliac) | Cylindrical, single-piece graft |
| Access Route | Femoral artery (groin) | Usually femoral; sometimes arm/neck |
| Main Risk Concerns | Endoleak, iliac perfusion | Neurological complications (CNS) |
Anatomical and Device Design Considerations
- Abdominal Aorta (EVAR): Bifurcation requires legged stent design
- Thoracic Aorta (TEVAR): Straight cylindrical graft suffices
Advantages of EVAR
- Minimally Invasive: No large abdominal incision
- Lower Operative Risk: Fewer complications such as bleeding or infection
- Local Anesthesia Option: Safer for elderly or comorbid patients
- Short Hospital Stay: 2–3 days on average
- Quick Return to Activities
- Low Blood Loss: Rarely requires transfusions
Risks of EVAR
Like all procedures, EVAR has potential complications, most of which are manageable:
- Endoleak: Blood leaks into aneurysm sac
- Stent Migration: May require reintervention
- Access Site Bleeding or Vascular Injury
- Allergic Reactions to contrast
- Temporary Kidney Impairment (especially in older patients)
Proper patient selection and expert surgical teams significantly reduce these risks.
Life After EVAR
Patients generally enjoy a high quality of life post-EVAR, but adherence to medical advice is key:
- Medication Compliance: Antiplatelets, cholesterol-lowering drugs
- Lifestyle Adjustments: No smoking, blood pressure control
- Exercise: Avoid heavy lifting for 6 weeks
- Surveillance: Annual CT scans to monitor graft status
Frequently Asked Questions
How long does EVAR surgery take?
Typically between 1–2 hours. It is significantly shorter than open surgery due to its less invasive nature.
What’s the difference between EVAR and TEVAR?
EVAR is used for abdominal aneurysms; TEVAR is for thoracic. They differ in graft design, application area, and access points.
When can I return to normal activities after EVAR?
Most patients resume light walking within 3–5 days. Desk workers may return within a week. Strenuous activity should be avoided for 4–6 weeks.
What is a stent graft and how is it used in EVAR?
A stent graft is a fabric-covered metallic mesh placed inside the aorta to redirect blood flow and isolate the aneurysm.
Is EVAR suitable for every abdominal aneurysm?
Not always. Aneurysm size, shape, neck length, and vessel angulation determine suitability. Some cases require open surgery.
What is the EVAR follow-up schedule?
CT angiography at 1, 6, and 12 months post-procedure, then annually for life to check for leaks, migration, or blockages.
How is EVAR different from open aneurysm surgery?
EVAR is endovascular (via blood vessels); open surgery involves a large abdominal incision and direct repair. EVAR is less invasive with quicker recovery.
What are the long-term success rates of EVAR?
Over 90% in properly selected patients. Long-term success depends on regular monitoring to catch complications early.
How long does the stent graft last after EVAR?
Properly placed grafts can last many years—often lifelong. Rarely, they may require revision due to movement or wear.
What should I watch for after EVAR?
Monitor blood pressure, avoid smoking, attend all follow-ups, and take medications as prescribed. Gradually increase physical activity under medical guidance.
* Contents of this page is for informational purposes only. Please consult your doctor for diagnosis and treatment. The content of this page does not include information on medicinal health care at Liv Hospital .
