Endovascular Aneurysm Repair (EVAR)
EVAR is a minimally invasive surgical procedure utilized to treat aortic aneurysms, predominantly those occurring below the kidneys (Abdominal Aortic Aneurysms). The primary goal of aneurysm repair is to prevent its enlargement or rupture, which could lead to dangerous internal bleeding.
Why Choose EVAR?
EVAR has become a widely used method for treating abdominal aortic aneurysms, conferring several benefits:
- Minimally Invasive: Via small incisions, usually in the groin.
- Shorter Recovery Time and Quicker Discharge: Patients often have briefer hospital stays and can return to normal activities sooner compared to open surgery.
- Lower Initial Risk and Enhanced Safety for High-Risk Patients: EVAR might be a safer alternative for patients considered high-risk for open surgery due to pre-existing medical conditions.
- Reduced Pain and Discomfort: Patients generally experience less pain during recovery compared to open surgery.
However, it’s vital to note that EVAR isn’t universally suitable. The procedure might not be viable for patients with certain anatomical limitations. Moreover, its long-term durability compared to open repair has been questioned.
A meticulous assessment of your anatomical and medical considerations—taking into account your preferences—should be conducted by your vascular surgeon before deciding on the suitability of this procedure.
How is EVAR Performed?
Pre-Procedure
Before the procedure, you will undergo several diagnostic tests, including CT scans, to assess the size and location of the aneurysm. Your vascular surgeon will carefully review these scans to plan an aortic stent-graft that is custom-fitted to your anatomy.
The Procedure
- Anesthesia: EVAR is typically performed under general anesthesia, ensuring you’re asleep and pain-free throughout.
- Accessing the Aorta: Small incisions are made in the groin area to access the femoral arteries.
- Inserting the Stent-Graft: Guided by real-time X-ray imaging (fluoroscopy), a catheter is navigated through the artery to the aneurysm site. A stent-graft—a metal mesh tube covered with synthetic fabric—is positioned within the aorta to reinforce the weakened artery section.
- Sealing the Aneurysm: Once in place, the stent-graft expands to fit snugly against the aorta wall, rerouting blood flow away from the aneurysm, thereby reducing pressure and the risk of rupture.
- Closure: After ensuring the stent-graft’s secure positioning, the catheter is removed and the incisions in the groin are closed.
Recovery Period
Post-procedure, you’ll be monitored in the recovery room before being transferred to a hospital room. High-risk patients might require a stay in a High-Dependency ward or even the ICU for closer post-operative monitoring. While some patients are discharged within 2-3 days, others might require a lengthier stay.
Post-Procedure Care and Follow-Up
Upon discharge, you’ll receive specific instructions related to wound care, activity restrictions, and follow-up appointments. Periodic monitoring via imaging tests will be necessary to ensure the stent-graft remains effectively in place and the aneurysm isn’t expanding.
Risks and Considerations
Although EVAR is widely regarded as a safe and effective procedure, like any surgery, it carries certain risks, including endoleaks (leakage around the stent-graft), infection, and possible stent-graft movement. Your surgeon will discuss these risks and evaluate your eligibility, ensuring the benefits outweigh potential risks.
FAQ about Endovascular Aneurysm Repair (EVAR)
EVAR is a minimally invasive procedure used to treat aortic aneurysms, specifically those in the abdominal and chest region, by reinforcing the weakened portion of the aorta with a stent-graft.
- EVAR involves smaller incisions and is generally less invasive than open surgery, which usually involves a large incision in the abdomen.
- Advantages of EVAR include a shorter recovery period, less pain post-operation, reduced risk of complications during and after the procedure, and its suitability for high-risk patients.
- An ideal candidate for EVAR is typically an individual with an abdominal aortic aneurysm, particularly those at higher risk for traditional open surgery due to factors such as age and underlying medical co-morbidities. Additionally, the candidate should have a favorable aortic anatomy that would permit a secure seal of the stented portion.
The EVAR procedure entails making a small incision in the groin through which a catheter is inserted. A stent-graft is then guided to the appropriate location to seal off the aneurysm and divert blood flow away from it, all under the meticulous guidance of real-time X-ray imaging.
Following the procedure, you will be monitored in the recovery room before being transferred to a standard hospital room. High-risk patients may require a stay in a High-Dependency ward or possibly the Intensive Care Unit (ICU) for closer post-operative monitoring.
You should be able to walk the day after the procedure and expect to be discharged within 2-3 days. Recovery after EVAR typically involves shorter hospital stays and less pain compared to open surgery. While there will be some initial restrictions on physical activity, most patients can return to their normal activities within a few weeks.
Even though EVAR is a minimally invasive procedure, it is still considered major surgery. As with all surgeries, inherent risks are involved. Some of the risks specific to EVAR include endoleak, infection, and complications related to the stent, such as fractures, blockages, or migration.
Dr. Lim will thoroughly discuss the potential risks and tailor an individualized treatment plan should you require this surgery.
Follow-up after EVAR typically involves regular imaging tests, such as CT scans, to ensure the stent-graft remains in place without leakage (referred to as ‘endoleak’) and to verify that the aneurysm is not expanding.
Embracing certain lifestyle alterations, such as adopting heart-healthy habits and incorporating regular exercise, might be advised after undergoing EVAR. Maintaining optimal blood pressure control also plays a pivotal role in ensuring favorable long-term outcomes post-procedure.
EVAR has proven to be highly effective in treating abdominal aortic aneurysms, preventing rupture, and providing a minimally invasive alternative to open surgery in specific cases.
Yes, however, the suitability of EVAR for complex aneurysms hinges upon specific anatomical and medical considerations, meticulously evaluated by your vascular surgeon.
Dr. Lim, having accrued extensive experience in strategizing and executing EVAR for patients with potentially complex or atypical aneurysms, welcomes the opportunity to discuss your situation should you require such a procedure.
Costs for EVAR can vary, influenced by factors such as the hospital and insurance coverage. While most insurance plans do cover EVAR, consulting with your insurance provider is essential.
An EVAR typically takes approximately 1-3 hours, with the duration varying based on the anatomical complexity of the aneurysm.
Open aortic repair surgery serves as the primary alternative to EVAR, especially for aneurysms with an anatomy unsuitable for stenting.
Yes, but anticipate some temporary restrictions following surgery. After an initial recovery period, most patients are able to resume their regular physical activities within 1-2 weeks.
Stent-grafts used in EVAR are typically composed of a metal framework, often made from stainless steel or nitinol, and are covered with synthetic fabric. The exact materials can vary depending on the manufacturer.
For instance, the Endurant stent-graft from Medtronic has components made of nitinol metal stents, which are sewn onto a multifilament polyester (PET [polyethylene terephthalate]) graft fabric.
The stent-graft used in EVAR reinforces the aorta by redirecting blood flow within the stent, which alleviates pressure on the aneurysm wall and consequently minimizes the potential for rupture.
EVAR has generally high success rates, with low early mortality and quick recovery periods.
