Endovascular Aneurysm Repair (EVAR) – Frequently Asked Questions

Endovascular Aneurysm Repair (EVAR) is a minimally invasive procedure used to treat aortic aneurysms, particularly those in the abdomen known as Abdominal Aortic Aneurysms (AAA). The procedure involves placing a stent-graft inside the aorta to reinforce the weakened artery wall, reducing the risk of rupture.

EVAR is commonly used to treat aortic aneurysms, which occur when the artery wall weakens and forms a bulge. If left untreated, large aneurysms can rupture, causing life-threatening internal bleeding. EVAR helps prevent this by diverting blood flow away from the weakened section of the aorta.

EVAR is recommended for patients diagnosed with an abdominal aortic aneurysm (AAA) that: 

✔ Is larger than 5.5 cm in men or 5.0 cm in women. 

✔ Is rapidly growing (more than 0.5 cm in six months). 

✔ Shows signs of rupture risk or if it is significantly compressing on surrounding organs in the abdomen

✔ Causes symptoms such as abdominal or back pain

EVAR is a preferred alternative to open surgery because it is less invasive and has several benefits: 

✔ Shorter recovery time – Patients typically stay in the hospital for only a few days. 

✔ Lower surgical risk – Safer for individuals with other health conditions such as heart or lung disease. 

✔ Less post-operative pain – Small groin incisions instead of a large abdominal incision. 

However, not all aneurysms can be treated with EVAR. The size, shape, and location of the aneurysm must be suitable for a stent-graft. In some cases, open surgery may be a better long-term solution.

The key component of EVAR is the stent-graft, a metal framework covered in fabric. This device is inserted through small incisions in the groin and guided to the aneurysm using X-ray imaging. Once in place, the stent-graft expands against the artery walls, creating a new channel for blood flow and reducing pressure on the aneurysm.

Before the procedure, patients undergo imaging tests, typically a CT scan, to accurately assess and measure the aneurysm. This in turn helps determine whether EVAR is suitable, as well as the right stent-graft size required. Blood tests and other evaluations ensure the patient is fit for surgery. Proper planning is crucial for a successful procedure.

Step 1: Anaesthesia – EVAR is usually performed under general anaesthesia, though some patients may receive local anaesthesia with sedation. 

Step 2: Small Incisions in the Groin – The femoral arteries are accessed through tiny cuts. 

Step 3: Catheter Placement – A flexible catheter is inserted and guided across the aneurysm with the help of X-ray guidance.. 

Step 4: Stent-Graft Deployment – The stent-graft is expanded inside the aorta, reinforcing the artery and preventing further bulging. 

Step 5: Completion – Once positioned correctly, the catheter is removed, and the incisions are closed. 

The procedure typically takes anywhere from 1 to 3 hours, depending on the complexity of the case.

The EVAR procedure typically takes anywhere from 1 to 3 hours, depending on the complexity of the case.

Most patients stay in the hospital for 2 to 3 days, though those with other health concerns may require additional monitoring. Generally, the recovery process involves: 

✔ Caring for the incision sites. 

✔ Gradually resuming physical activities. 

✔ Regular follow-up scans to ensure the stent-graft remains in place.

EVAR is generally a safe procedure, but potential risks include: 

⚠ Endoleaks – When blood leaks around or within the stent-graft. 

⚠ Stent movement – The stent-graft may shift over time. 

⚠ Infections or blood clot formation. 

⚠ Need for additional procedures if complications arise. 

Regular follow-up imaging helps detect and address these issues early.

The stent graft is designed to be a long-term solution.

Lifelong follow-up is essential after EVAR. Routine ultrasound or CT scans monitor the stent-graft and check for any leaks or shifts. This ensures that the aneurysm remains stable and the repair continues to be effective.

If you are considering Endovascular Aneurysm Repair (EVAR) for your aortic aneurysm, Dr. Darryl Lim can assess your condition and determine the best treatment approach.

📍 Visit: Novena Vascular & Varicose Vein Centre. 38 Irrawaddy Rd, #08-48, Singapore 329563
📞 Call or drop a message on WhatsApp: (+65) 9727-0788
📧 Email: contact@drdarryllim.com
🌐 Website: https://drdarryllim.com