Last Updated on November 26, 2025 by Bilal Hasdemir

At Liv Hospital, we use the endovascular aortic aneurysm repair (EVAR) method to treat dangerous aortic aneurysms. This minimally invasive procedure puts a stent-graft through the femoral arteries. It blocks the aneurysm and helps blood flow normally, greatly lowering the risk of rupture.

We know patients looking into treatments for aortic aneurysms want to know the pros and cons of the EVAR surgical procedure. Our team is here to offer world-class treatment. We combine safety, expertise, and the newest in vascular care.

Key Takeaways

• EVAR is a minimally invasive procedure used to treat abdominal aortic aneurysms.
• The procedure involves inserting a stent-graft to exclude the aneurysm and restore blood flow.
• EVAR reduces the risk of aneurysm rupture and promotes faster recovery.
• Our team at Liv Hospital is committed to delivering international-level outcomes.
• Patients receive complete care, including guidance and support throughout the treatment process.

Understanding Abdominal Aortic Aneurysms (AAA) and Their Risks

Abdominal aortic aneurysms are serious health issues. It’s important to know what causes them and their risks. An aneurysm happens when the aorta, the main blood vessel, gets too big. This can be very dangerous if not treated right.

What Causes Aortic Aneurysms

Aneurysms are often caused by a weak aortic wall. Smoking and high blood pressure can weaken it. Also, if you have a family history of aneurysms, you’re at higher risk.

Other things like atherosclerosis and trauma can also cause aneurysms. Knowing these causes helps doctors understand your risk and decide the best treatment.

Why Untreated Aneurysms Are Dangerous

Untreated aneurysms can be very dangerous. The biggest risk is rupture. A rupture can cause severe bleeding, shock, organ failure, and even death. The bigger the aneurysm, the higher the risk of rupture.

When Medical Intervention Becomes Necessary

Medical help is needed when the risk of rupture is too high. For many, Endovascular Aneurysm Repair (EVAR) is a good choice. It’s less invasive and has quicker recovery times than open surgery.

The choice of treatment depends on many things. These include the aneurysm’s size and location, the patient’s health, and other factors. We’ll talk more about EVAR and when it’s used in the next sections.

What Is EVAR: Defining the Endovascular Aneurysm Repair Procedure

The EVAR procedure has changed how we treat aortic aneurysms. It’s a less invasive option compared to traditional open surgery. This method uses a stent-graft to block blood flow to the aneurysm, stopping it from growing or rupturing.

Endovascular Aneurysm Repair (EVAR) is great for those at high risk from open surgery. It uses advanced imaging and custom stent-grafts for a precise treatment.

The Evolution of EVAR Treatment

EVAR has made big strides in vascular surgery. It started as a less invasive option and has grown with new stent-graft designs and imaging. These advancements have made EVAR available to more patients.

How EVAR Differs from Open Surgical Repair

EVAR is different from open surgery because it’s done through small groin incisions. This approach causes less damage and leads to less pain and quicker recovery.

Unlike open surgery, EVAR uses imaging to guide the stent-graft placement. This ensures the aneurysm is properly blocked.

When EVAR Is Medically Indicated

EVAR is recommended for certain patients with abdominal aortic aneurysms (AAA). The decision is based on the aneurysm’s size, shape, and the patient’s health.

Those with complex aneurysms or high risk for open surgery are often good candidates for EVAR. The choice to use EVAR depends on the patient’s specific needs and preferences.

The EVAR Surgical Procedure: Step-by-Step Process

The EVAR surgical procedure is a detailed process aimed at improving patient outcomes. Each step is designed with care to ensure success. The procedure is complex, needing careful planning and execution.

Pre-Operative Preparation and Imaging

Before starting the EVAR procedure, thorough preparation is key. We use imaging studies to check the aneurysm’s size, shape, and location. We also look at the blood vessels around it.

Advanced imaging like CT angiography gives us detailed information about the patient’s anatomy. This helps us plan the best approach for placing the stent-graft.

Anesthesia Options for EVAR

The EVAR procedure can be done under different types of anesthesia. This depends on the patient’s health and the complexity of the case. Local anesthesia with sedation is often used to keep patients comfortable and reduce risks.

In some cases, general anesthesia might be needed. This is usually if the patient’s condition requires close monitoring or if the procedure is complex. Our anesthesiologists work with our vascular surgeons to choose the best anesthesia for each patient.

Stent-Graft Insertion Technique

The EVAR procedure focuses on placing a stent-graft in the aorta. This device strengthens the weakened section of the aorta. It prevents the aneurysm from getting bigger or rupturing.

We use small incisions in the groin to access the aorta. Then, we use catheters and guidewires to guide the stent-graft into place. Fluoroscopy helps us see where the stent-graft is going.

Intraoperative Imaging Guidance

During the EVAR procedure, we use advanced imaging to guide the stent-graft placement. Techniques like digital subtraction angiography and fluoroscopy give us real-time images. This lets us see how the stent-graft is deployed and its position relative to the aneurysm.

This imaging is key to achieving the best results and reducing the risk of complications during and after the procedure.

Patient Selection Criteria for EVAR Vascular Treatment

EVAR vascular treatment needs careful patient selection for the best results. The success of the EVAR procedure depends on evaluating the patient’s anatomy and other important factors.

Anatomical Requirements for Successful EVAR

Several key factors determine if a patient is suitable for EVAR. These include the size and shape of the abdominal aortic aneurysm (AAA). Also, the presence of suitable landing zones for the stent-graft and the condition of the access vessels are important.

A study in the Journal of Vascular Surgery found that the aneurysm’s shape and the surrounding blood vessels are key. This shows how important detailed imaging and assessment are in choosing patients.

Landing Zone Considerations

The placement of the stent-graft needs adequate landing zones. These are the areas where the stent-graft will be placed in the aorta, above and below the aneurysm. These areas must be long enough and free of calcification or thrombus for a good seal.

• Proximal landing zone: The area above the aneurysm where the stent-graft will be anchored.
• Distal landing zone: The area below the aneurysm where the stent-graft will be sealed.

Access Vessel Assessment

The condition and size of the access vessels, usually the femoral arteries, are key for the stent-graft delivery. These vessels must be large enough and relatively free of disease to fit the delivery system.

“Careful evaluation of the access vessels is essential to avoid complications during the EVAR procedure.”

In conclusion, choosing patients for EVAR vascular treatment requires a thorough assessment. This includes looking at the patient’s anatomy, like landing zones and access vessels. By carefully checking these, healthcare providers can help patients get the best results from EVAR aortic aneurysm repair.

Types of Stent-Grafts Used in Abdominal Aortic Aneurysm EVAR

In EVAR, different stent-grafts are used for various patients. The right stent-graft is key for success. It must match the patient’s blood vessel anatomy.

Modular Stent-Graft Systems

Modular stent-graft systems are common in EVAR. They are flexible and can be adjusted to fit each patient. The modular design lets doctors make changes during surgery for better fit.

Modular stent-grafts offer many benefits:

• They can be customized for different aortic shapes
• Allow for changes during surgery
• Lower risk of problems due to accurate sizing

Fenestrated Devices for Complex Cases

Fenestrated devices are for complex aortic aneurysms. They have precisely located fenestrations to keep blood flowing to important organs.

These devices make EVAR possible for more patients. This is because they can handle complex anatomy.

The Zenith Fenestrated (ZFEN) Stent

The Zenith Fenestrated (ZFEN) stent is a special fenestrated device. It’s for patients with juxtarenal aneurysms. It has reinforced fenestrations for better durability and blood flow.

Choosing the Right Device for Individual Anatomy

Choosing the right stent-graft for EVAR is important. It depends on the patient’s anatomy, like the aneurysm size and branch vessels. Advanced imaging helps with precise planning.

By picking the right device, doctors can improve EVAR outcomes. This reduces complications and helps patients recover faster.

Recovery and Post-Operative Care After EVAR Surgery

EVAR surgery is a minimally invasive procedure. It allows patients to recover faster and with fewer complications than traditional surgery. A smooth recovery is key to the treatment’s success.

Hospital Stay Duration

EVAR surgery means a shorter hospital stay. Patients are usually discharged in 1 to 3 days. But, this can change based on health and any complications.

Activity Restrictions Following EVAR

Patients need to follow activity restrictions for a good recovery. These include:

• Avoiding heavy lifting (more than 10 pounds) for at least 4-6 weeks
• Limiting strenuous activities and exercises for 6-8 weeks
• Gradually resuming normal activities as advised by their healthcare provider

Following these guidelines helps prevent complications and aids in healing.

Long-Term Follow-Up Requirements

Long-term follow-up is key after EVAR surgery. It’s to check the stent-graft’s position and function, and for any complications like endoleaks. We recommend a follow-up schedule that includes:

1. Imaging tests (e.g., CT scans) at 1, 6, and 12 months post-procedure
2. Annual follow-up imaging thereafter
3. Regular check-ups with a vascular specialist

This ongoing surveillance helps in early detection and management of any issues that may arise.

Signs of Complications to Monitor

While EVAR surgery is generally safe, it’s important for patients to watch for signs of complications. These include:

• Severe abdominal or back pain
• Leg pain or weakness
• Signs of infection (fever, redness, swelling at the incision site)
• Changes in urine output or bowel habits

If any of these symptoms occur, patients should seek immediate medical attention.

Understanding the recovery process and following post-operative care instructions can greatly improve outcomes after EVAR surgery. Our team is committed to providing full support throughout the recovery journey.

Potential Risks and Complications of EVAR Procedures

It’s important for patients to know about the risks of EVAR. This procedure is usually safe but can have some complications. Knowing these risks helps patients and doctors make better choices.

Immediate Procedural Complications

During EVAR, some immediate problems can happen:

• Bleeding or hematoma at the access site
• Vascular injury or rupture
• Stent-graft misdeployment
• Allergic reactions to contrast agents

These issues are rare but need quick action to avoid serious problems.

Endoleaks: Types and Management

Endoleaks are a common issue with EVAR. They happen when blood leaks into the aneurysm sac. There are different types, each needing its own treatment:

• Type I: Leak at the attachment site
• Type II: Retrograde flow from branches
• Type III: Leak through the graft
• Type IV: Graft porosity
• Type V: Endotension without visible leak

Managing endoleaks well is key to avoiding rupture. This might mean more treatments, like embolization or adding more stent-grafts.

Device Migration and Structural Issues

Over time, the stent-graft can move or have structural problems. This might cause endoleaks or blockages. Regular checks are needed to keep an eye on the stent-graft’s position and condition.

Long-Term Surveillance Needs

Keeping an eye on EVAR patients over the long term is vital. They need regular scans to watch for issues like endoleaks, stent-graft movement, and aneurysm growth. This early detection helps in treating problems quickly, improving outcomes.

In summary, EVAR is a good option for treating aortic aneurysms, but knowing the risks is key. Understanding these risks helps both patients and doctors make better choices and care plans.

Benefits of EVAR Compared to Open Surgical Repair for Aortic Aneurysm

Endovascular Aneurysm Repair (EVAR) has changed how we treat aortic aneurysms. It offers many advantages over traditional open surgery. This minimally invasive method is now the top choice for many patients.

Reduced Recovery Time and Hospital Stay

One big benefit of EVAR is the shorter recovery and hospital stay. EVAR uses small incisions, causing less damage. This leads to fewer complications and a quicker recovery.

Research shows EVAR patients usually leave the hospital in less than 2 days. Some are even home in 24 hours. Open surgery, on the other hand, often keeps patients in the hospital for a week or more.

Lower Perioperative Mortality

Looking at EVAR vs open repair, EVAR has lower death rates during and right after surgery. This is true, even for older patients or those with serious health issues. EVAR’s minimally invasive approach lowers the risk of immediate complications.

Quality of Life Considerations

The quality of life after EVAR is often better than after open surgery. Patients feel less pain and get back to normal faster. This is key for older patients or those with other health issues.

Success Rates and Long-Term Outcomes

The long-term outcomes of EVAR are very good. EVAR’s survival rates are similar to open surgery, sometimes better. Regular check-ups are needed to watch for any issues like endoleaks.

In summary, EVAR is a great choice for treating aortic aneurysms. It offers quick recovery, lower death rates, better quality of life, and good long-term results. EVAR is changing how we treat this serious condition.

Conclusion: The Future of EVAR in Treating Aortic Aneurysms

EVAR has changed how we treat abdominal aortic aneurysms (AAAs). It offers a less invasive option compared to open surgery. The Ovation polymer-based endograft shows great success and long-term benefits for patients with certain types of AAA.

Studies have shown low rates of complications and deaths related to the aneurysm. This proves EVAR is safe and effective. The future of EVAR looks bright, with new technologies and techniques on the horizon.

These advancements will make EVAR even safer and more durable. More patients will have access to this life-saving treatment. As EVAR evolves, we’re committed to delivering top-notch healthcare worldwide.

We aim to provide effective, minimally invasive treatments for aortic aneurysms. Our mission is to make a difference in patients’ lives.

FAQ

References:

• Greenhalgh, R. M., Brown, L. C., Kwong, G. P. S., Powell, J. T., & Thompson, S. G. (2004). Endovascular versus open repair of abdominal aortic aneurysm. The New England Journal of Medicine, 351(16), 1607–1618. https://pmc.ncbi.nlm.nih.gov/articles/PMC3632841/
• Mani, K., & Ricco, J.-B. (2024). Endovascular aneurysm repair for abdominal aortic aneurysms: Current perspectives and future directions. Journal of Vascular Surgery.https://pmc.ncbi.nlm.nih.gov/articles/PMC6658877/