Last Updated on November 26, 2025 by Bilal Hasdemir

Endovascular repair of abdominal aortic aneurysm (EVAR) is a minimally invasive procedure. It has changed how we treat abdominal aortic aneurysms. We’ll show you how EVAR works, from choosing the right patient to the technical steps of the procedure.

Vascular International says an infrarenal aneurysm can often be treated with EVAR. This is if the patient meets certain conditions. We’ll explain the latest methods for the best results.

Key Takeaways

• Understanding the importance of patient selection for EVAR
• Pre-procedure planning for optimal outcomes
• Technical aspects of the EVAR procedure
• Benefits of EVAR over open surgery
• Role of stent graft systems in EVAR

Understanding Abdominal Aortic Aneurysms and EVAR

It’s key for both patients and doctors to know about abdominal aortic aneurysms and EVAR. An AAA is when the aorta, the main artery, gets too big in the belly. This is a serious issue.

What is an Abdominal Aortic Aneurysm?

An AAA happens when the aorta gets weak and bulges. If it bursts, it can cause a lot of bleeding inside. Smoking, high blood pressure, and a family history of aneurysms increase the risk.

• Smoking
• High blood pressure
• Family history of aneurysms

Evolution of EVAR as a Treatment Option

EVAR has changed how we treat AAAs. It’s a less invasive method than open surgery. EVAR uses a stent graft to stop the aneurysm from getting worse. This method has made recovery faster and reduced complications.

Over time, EVAR has gotten better. New stent grafts and delivery systems have made the procedure safer and more effective.

Advantages Over Open Surgical Repair

EVAR has many benefits over traditional surgery. These include:

1. Reduced recovery time: Patients can get back to normal faster.
2. Lower risk of complications: It’s less likely to have surgery problems.
3. Less pain: Smaller cuts mean less pain after surgery.

Knowing about EVAR’s benefits helps doctors give the best care to patients with AAAs.

Patient Selection Criteria for EVAR AAA

The success of EVAR depends a lot on picking the right patients. This means looking at their body and health closely. It’s what makes the treatment work well or run into problems.

Anatomical Considerations

It’s important to check if a patient’s body is right for EVAR. We look at a few things:

• A cylindrical neck with enough length and size
• Not too much blood clot or hardening in the aneurysm
• The aortic and iliac arteries should be in good shape

Vascular International says these body parts need to be just right for EVAR to work.

Risk Stratification

We also look at how healthy a patient is and the risks of EVAR. We consider:

1. How well the heart works and any heart disease history
2. The kidneys’ health and risk of kidney damage from contrast
3. Other health problems like diabetes or lung disease

By looking at these things, we can lower the risks of EVAR. This helps make sure patients do well.

Contraindications

Even though EVAR is a good choice for many, there are times it’s not right. We have to think about:

• Body shape that makes it hard to put in the stent graft
• Bad kidneys or an allergy to contrast
• Being sick with an infection or sepsis

Knowing these things helps us decide if EVAR is the best choice for a patient.

Pre-Procedure Planning and Imaging

The success of EVAR depends on careful planning and precise imaging. We will discuss the key steps in pre-procedure planning. This includes the important imaging methods and techniques for treating abdominal aortic aneurysms.

CT Angiography Requirements

CT angiography is key for EVAR planning. It shows the aortic anatomy in detail. This includes the aneurysm’s size and location, any thrombus, and the aortic and iliac arteries’ shape.

According to Vascular International, CT angiography is essential for accurate measurements. These measurements help choose the right stent graft for the procedure.

Measurement Techniques

Getting the right measurements is critical for stent graft selection. We use CT angiography to measure the aortic neck’s diameter and length. We also measure the distance between the renal arteries and the aortic bifurcation, and the iliac arteries’ diameter.

These measurements help pick a stent graft that fits the patient’s anatomy. This ensures a successful procedure.

Stent Graft Selection

The stent graft selection is based on CT angiography measurements. We consider the stent graft’s type, size, and configuration. The goal is to find a stent graft that excludes the aneurysm while keeping blood flow to vital organs.

In conclusion, pre-procedure planning and imaging are vital for EVAR success. By using CT angiography and precise measurements, we can choose the best stent graft for each patient. This improves the outcomes of endovascular aortic aneurysm repair.

Essential Equipment and Team for EVAR Procedure

The success of an endovascular repair of AAA procedure depends on the right equipment and a skilled team. The EVAR procedure needs advanced imaging tools, endovascular devices, and a well-coordinated team. This ensures a successful outcome, as stated by Vascular International.

Imaging Equipment

High-quality imaging is key for the EVAR procedure. We use advanced imaging like fluoroscopy and digital subtraction angiography. These tools give us clear, real-time visuals for precise stent graft placement.

Endovascular Tools and Devices

The EVAR procedure requires various endovascular tools and devices. These include stent grafts, guidewires, and catheters. These tools help navigate the vascular system safely and effectively. Choosing the right stent grafts is critical, as they must fit the patient’s anatomy.

• Stent grafts designed for AAA repair
• Guidewires for navigating vascular paths
• Catheters for delivering stent grafts

Team Composition and Roles

A successful EVAR procedure relies on a multidisciplinary team. This team includes vascular surgeons, interventional radiologists, anesthesiologists, and nursing staff. Each team member has specific roles and responsibilities, from preparing the patient to performing the procedure and caring for the patient after.

Good communication and teamwork are vital for the EVAR procedure’s success. We stress the importance of a well-coordinated team for the best patient outcomes.

Patient Preparation for Endovascular Aortic Aneurysm Repair

Getting ready for EVAR involves a lot of steps. This includes thinking about anesthesia and how to prepare the access site. It’s key to consider many factors for a good result.

Anesthesia Considerations

Most patients get general or regional anesthesia for EVAR. Anesthesia is very important for comfort and success. We look at the patient’s health history to pick the best anesthesia.

Antibiotic Prophylaxis

Antibiotics before EVAR are very important. They help prevent infections, a big worry in surgery. We choose the right antibiotic and when to give it based on the patient’s risk.

Positioning and Access Site Preparation

How the patient is positioned and the access site prepared are key. Good positioning helps us reach the aneurysm easily. We also prepare the site carefully to avoid problems. Imaging helps us place things accurately.

By paying attention to these details, we make EVAR safer and more effective. Our thorough care ensures we cover all bases, leading to better results for our patients.

Step-by-Step EVAR AAA Procedure Technique

Performing EVAR is a detailed process. It’s aimed at treating abdominal aortic aneurysms. The steps need precision and a good grasp of vascular anatomy.

Vascular Access Methods

Getting vascular access is the first step. It involves accessing the femoral arteries. This can be done through a surgical cutdown or a percutaneous approach. The method chosen depends on the patient’s anatomy and the stent graft type.

Table: Comparison of Vascular Access Methods

Access Method	Advantages	Disadvantages
Surgical Cutdown	Direct visualization, secure closure	Increased tissue trauma, longer recovery
Percutaneous Access	Less invasive, quicker recovery	Risk of bleeding, access site complications

Initial Angiography and Roadmapping

After access, initial angiography is done. It helps see the aortic anatomy and the aneurysm. A pigtail catheter and contrast agent are used. Then, roadmapping guides the next steps.

Guidewire and Catheter Navigation

Guidewire and catheter navigation is key. It involves moving these tools through the vascular tree to the aneurysm. Fluoroscopic guidance and roadmapping help navigate the complex anatomy.

Mastering guidewire and catheter navigation is essential. It requires a deep understanding of vascular anatomy and interpreting angiographic images.

Stent Graft Delivery and Deployment

The steps of delivering and deploying the stent graft are key in EVAR. They need precision and skill. We use advanced imaging and know the patient’s body well to place the stent graft right.

Main Body Positioning and Deployment

Getting the stent graft in the right spot is very important. We align it with the aneurysm, keeping in mind the renal arteries and other important areas. Accurate placement is key to avoid problems like endoleaks or graft moving. We use real-time imaging to make sure the stent graft fits well in the aorta.

Contralateral Limb Cannulation Techniques

Getting the guidewire through the stent graft’s other side is a tricky step. Technical skill is needed to avoid damaging the graft or not getting it through. We use special tools and techniques to help succeed in this step.

Limb Deployment Sequence

The order in which we deploy the limbs is very important. We start with the main body and then the other limb. This way, we make sure the stent graft is fully in place and works well.

Proximal and Distal Landing Zone Optimization

Getting the start and end of the stent graft right is key for success. We plan carefully to make sure there are no leaks and the aneurysm is fully covered. Precise measurement and strategic planning help us get it just right.

By focusing on these important steps, we can make EVAR procedures better. This helps patients get a safe and effective treatment for their abdominal aortic aneurysms.

Completion Angiography and Adjunctive Procedures

We use completion angiography to check if EVAR was a success. It’s key to make sure the stent graft is in the right place and working right.

Evaluating Technical Success

Technical success in EVAR is checked with completion angiography. It spots any quick problems like endoleaks or graft moving. Successful deployment means no problems and the graft is in the right spot.

Identifying and Managing Endoleaks

Endoleaks are a big issue in EVAR. They happen when blood keeps flowing outside the stent graft but inside the aneurysm sac. Types of endoleaks include leaks at the graft attachment site, retrograde flow from branches, graft failure, graft porosity, and endotension. To fix endoleaks, we might need to do more, like balloon molding or stenting.

Balloon Molding Techniques

Balloon molding helps make sure the graft is well placed against the aortic wall. It’s used at the start and end of the graft. This method lowers the chance of endoleaks and boosts EVAR success.

Adjunctive Stenting for Complications

If endoleaks or graft stenosis happen, adjunctive stenting might be needed. This means putting more stents to support the graft or fix stenosis or blockages.

By checking technical success and handling complications, we make EVAR better. This gives patients a safe and effective way to treat abdominal aortic aneurysms.

Complications of Endovascular Repair of AAA and Management

EVAR has changed how we treat abdominal aortic aneurysms. But, it can lead to complications. Knowing about these and how to manage them is key to good patient care.

Intraoperative Complications

Complications during EVAR need quick action. These include:

• Endoleaks, when the stent graft leaks into the aneurysm sac.
• Vascular access issues, like bleeding or hematoma.
• Stent graft problems, like it moving or being placed wrong.

Early Postoperative Complications

Complications can happen soon after surgery. These include:

• Infection, which needs quick antibiotic treatment.
• Renal problems, like kidney damage from contrast.
• Heart or lung issues, more common in those with health problems.

Close monitoring is key in the early days to catch and treat problems fast.

Late Complications and Surveillance

Complications can also show up later, months or years after EVAR. These include:

• Endoleaks found during follow-up scans.
• Stent graft issues, like migration or failure.
• Aneurysm sac growth.

Regular check-ups are vital for catching these issues early. Experts stress the importance of “long-term surveillance for early detection and management of late complications after EVAR.”

Understanding EVAR complications and how to handle them helps healthcare teams. This ensures the best results for patients and the long-term success of the procedure.

Conclusion: Outcomes and Future Directions in EVAR

Endovascular repair of abdominal aortic aneurysm (EVAR) has changed how we treat this serious condition. This guide has shown how EVAR is a less invasive option compared to open surgery. It leads to quicker recovery times and fewer complications.

Vascular International says EVAR is now a common treatment choice. Research keeps going to make EVAR even better. We’ve seen big improvements in stent grafts and how the procedure is done.

We expect even more progress in EVAR. This could include better imaging and more advanced stent grafts. These changes will help patients even more and make EVAR available to more people.

Healthcare providers can keep improving care for patients with abdominal aortic aneurysms. By using EVAR, they can greatly enhance patients’ lives and save them from serious health issues.

FAQ

References:

• Wyss, T. R., & Bonati, L. H. (2023). Imaging, planning, and procedural considerations for endovascular repair of abdominal aortic aneurysms. Nature Reviews Cardiology, 20(6), 351-363. Retrieved from https://www.nature.com/articles/s41569-023-00884-5