Endovascular aortic aneurysm repair (EVAR)

What is EVAR?

Endovascular aortic aneurysm repair or EVAR as it known is a minimally invasive alternative to open repair.

How does EVAR work?

Unlike open surgery which is performed through an abdominal and/or chest incision under general anaesthesia, EVAR is performed through two small groin incisions under local, epidural or general anaesthesia. A stent-graft (a metal tube covered with synthetic graft material) is inserted through the femoral arteries (in the groins) into the aorta under x-ray guidance. The stent-graft is positioned accurately and expanded so that it seals above and below the aneurysm and the blood flows through it, rather than the aneurysm, so reducing the risk of aneurysm rupture.

What are the benefits and how safe is the treatment?

Most abdominal aortic aneurysms (AAA) commence below the arteries supplying the kidneys (so called infrarenal AAA). These aneurysms can be repaired with open surgery through an abdominal incision, or standard EVAR. The risk of post-operative death is lower with EVAR than with open surgery.

Some aneurysms commence close to the kidney arteries (so called juxtarenal AAA) whilst others may involve the arteries to the kidneys, intestines, liver and spleen (so called suprarenal AAA or thoraco-abdominal aneurysms). Open surgery is complex and may require an incision in the side of the chest as well as an abdominal incision. The risk of death and complications after open surgery is higher for these aneurysms than for infrarenal AAA. EVAR for these aneurysms requires a made-to-measure stent-graft with holes (fenestrations) in the graft material or small branches which ensure that blood continues to flow to the kidneys, intestines, liver and spleen. The risk of post-operative death is lower with EVAR than with open surgery.

After treatment, regular check-ups are required with x-rays and ultrasound scans to ensure that the stent-graft continues to seal off the aneurysm.

Acknowledgements

Author: Mr Donald Adam, Consultant Vascular & Endovascular Surgeon practising at BMI The Priory Hospital.

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