What Is EVAR? A Modern Aneurysm Solution
Aortic aneurysms are vascular abnormalities that typically develop without noticeable symptoms and can become life-threatening if they rupture, leading to severe internal bleeding. Most aneurysms do not cause symptoms and are usually discovered incidentally during imaging performed for unrelated reasons or during routine health 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. In this procedure, a stent graft is inserted into the affected segment of the aorta to reinforce the weakened vessel wall. This graft redirects blood flow through a secure channel, preventing further aneurysm enlargement or rupture.
Unlike open surgery, this technique is performed through small incisions in the groin using the femoral arteries. This approach results in less surgical trauma, faster recovery, and lower risk of complications”especially for carefully selected patients.
When Is EVAR Indicated?
Endovascular Aneurysm Repair is generally recommended for abdominal aortic aneurysms larger than 5.5 cm in diameter. However, it may also be considered for smaller aneurysms if they are growing rapidly or are believed to be at increased risk of rupture.
Ideal candidates for EVAR include:
- Aneurysms exceeding critical size thresholds
- Rapidly expanding aneurysms
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Patients with cardiac, pulmonary, or renal comorbidities (considered 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 Endovascular Aneurysm Repair is determined by a vascular surgeon following a thorough and comprehensive evaluation.
How EVAR Is Performed
Diagnosis and Planning
Endovascular Aneurysm Repair begins with CT angiography to assess aneurysm size, shape, and relationship to nearby arteries.
Step-by-Step EVAR Procedure:
- Access Site: A small incision is made in the groin to provide access to the femoral artery.
- Guidewire and Delivery System: A catheter containing the stent graft is carefully advanced into the abdominal aorta.
- Deployment of Stent Graft: Using imaging guidance, the stent graft is precisely positioned over the aneurysmal segment and then deployed to line the aortic wall.
- Redirected Blood Flow: Once placed, the graft directs blood flow through its interior, effectively shielding the aneurysm sac from pressure.
- Closure: After the catheters are removed, the access sites are closed. Most Endovascular Aneurysm Repair procedures are completed within 1“2 hours, and patients can usually 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:
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Patients receive information about the procedure, stent graft design, possible risks, expected graft lifespan, and follow-up requirements.
Stent Graft Selection:
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Grafts are tailored to each patient's unique anatomy. Key factors such as diameter, length, presence of bifurcation, and flexibility are considered during selection. When necessary, custom-made grafts can be designed to meet specific anatomical requirements.
Post-EVAR Recovery and Monitoring
- While Endovascular Aneurysm Repair is minimally invasive, long-term surveillance is crucial for sustained success.
Hospital Stay:
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Patients are monitored in the hospital for 24 to 48 hours after the procedure.
- 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 is essential after Endovascular Aneurysm Repair to detect potential complications, such as endoleaks, stent migration, or graft blockage, at an early stage.
What Is TEVAR (Thoracic Endovascular Aneurysm Repair)?
TEVAR (Thoracic Endovascular Aneurysm Repair) is a minimally invasive endovascular procedure, similar to Endovascular Aneurysm Repair, but specifically designed for treating thoracic aortic aneurysms”those that develop in the chest. These types of aneurysms may result from trauma, genetic conditions, or uncontrolled high blood pressure. As with EVAR, TEVAR involves placing a stent graft within the affected section of the thoracic aorta. This graft reinforces the weakened segment, reducing the risk of rupture and providing long-term stability.
EVAR vs. TEVAR: Key Differences
| 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, this technique 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 typically experience a high quality of life following this technique; however, consistent adherence to medical advice remains essential:
- 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
* Liv Hospital Editorial Board has contributed to the publication of this content .
* The contents of this page are for informational purposes only. Please consult your doctor for diagnosis and treatment. This page does not provide information about medical care at Liv Hospital.
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Frequently Asked Questions
How long does EVAR surgery take?
The procedure typically takes between 1 and 2 hours, which is significantly shorter than open surgery due to its less invasive approach.
What's the difference between EVAR and TEVAR?
EVAR is performed to repair abdominal aortic aneurysms, while this technique is used for thoracic aortic aneurysms. The two procedures differ in stent graft design, the region of the aorta they treat, and the routes used for vascular access.
When can I return to normal activities after EVAR?
Most patients can begin light walking within 3 to 5 days after this technique. Those with desk jobs are usually able to return to work within a week. Strenuous physical activities should be avoided for 4 to 6 weeks.
What is a stent graft and how is it used in EVAR?
A stent graft is a metallic mesh tube covered with fabric that is placed inside the aorta to reinforce the vessel wall, redirect blood flow, and seal off the aneurysm.
Is Endovascular Aneurysm Repair suitable for every abdominal aneurysm?
Not always. Aneurysm size, shape, neck length, and vessel angulation determine suitability. Some cases require open surgery.
What are the long-term success rates of EVAR?
Long-term success rates for this technique exceed 90% in appropriately selected patients. Ongoing, regular monitoring is essential to ensure early detection and management of potential complications.
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?
Regularly monitor your blood pressure, avoid tobacco use, attend all scheduled follow-up appointments, and take all medications exactly as prescribed. Gradually increase your physical activity, following your doctor's recommendations.