Definition

Endovascular abdominal aortic aneurysm (AAA) repair is surgery to repair a widened area in your aorta. This is called an aneurysm. The aorta is the large artery that carries blood from your heart to your belly, pelvis, and legs.

An aortic aneurysm is when a part of this artery becomes too large or balloons outward. It occurs due to weakness in the wall of the artery.

Alternative Names

EVAR; Endovascular aneurysm repair - aorta; AAA repair - endovascular; Repair - aortic aneurysm - endovascular

Description

This procedure is done in an operating room, in the radiology department of the hospital, or in a catheterization lab. You will lie on a padded table. You may receive general anesthesia (you are asleep and pain-free) or epidural or spinal anesthesia. During the procedure, your surgeon will:

• Make a small surgical cut near the groin, to find the femoral artery.
• Insert a thin, flexible tube (catheter) into the artery through the cut.
• Insert a stent (a metal coil) and a man-made (synthetic) graft along the catheter.
• Then use a dye to define the extent of the aneurysm.
• Use x-rays to guide the stent graft up into your aorta, to where the aneurysm is located.
• Next open the stent using a spring-like mechanism and attach it to the walls of the aorta. Your aneurysm will eventually shrink around it.
• Use x-rays and dye again to make sure the graft is in the right place and your aneurysm is not bleeding inside your body.
• Remove the catheter and close the surgical cut where the catheter was inserted.

Why the Procedure Is Performed

Endovascular aneurysm repair (EVAR) is done because your aneurysm is very large, growing quickly, or is leaking or bleeding.

You may have an AAA that is not causing any symptoms or problems. Your health care provider may have found this problem when you had an ultrasound or CT scan for another reason. There is a risk that this aneurysm may burst (rupture) if you do not have surgery to repair it. However, surgery to repair the aneurysm may also be risky. In such cases, EVAR is an option.

You and your provider must decide whether the risk of having this surgery is smaller than the risk for rupture if you do not have surgery to repair the problem. The provider is more likely to recommend that you have surgery if the aneurysm is:

• Larger (about 2 inches or 5 centimeters)
• Growing more quickly (a little less than 1/4 inch or 0.5 centimeter over the last 6 to 12 months)

EVAR has a lower risk of developing complications compared to open surgery. Your provider is more likely to suggest this type of repair if you have other serious medical problems or are an older person.

Risks

Risks of any surgery are:

• Blood clots in the legs that may travel to the lungs
• Breathing problems
• Infection, including in the lungs, urinary tract, and belly
• Heart attack or stroke
• Reactions to medicines

Risks of this surgery are:

• Bleeding around the graft that needs more surgery
• Bleeding before or after procedure
• Blockage of the stent
• Damage to a nerve, causing weakness, pain, or numbness in the leg
• Kidney failure
• Poor blood supply to your legs, your kidneys, or other organs
• Problems getting or keeping an erection
• Surgery is not successful and you need an open surgery
• The stent graft slips
• The graft leaks and requires open surgery
• Death

Before the Procedure

Your provider will examine you and order tests before you have surgery.

Always tell your provider what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.

If you are a smoker, you should stop. Your provider can help. Here are other things you will need to do before your surgery:

• About two weeks before your surgery, you will visit your provider to make sure any medical problems, such as diabetes, high blood pressure, and heart or lung problems, are well treated.
• You also may be asked to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), clopidogrel (Plavix), warfarin (Coumadin), and naproxen (Aleve, Naprosyn).
• Ask which drugs you should still take on the day of your surgery.
• Always tell your provider if you get a cold, flu, fever, herpes breakout, or other illness before your surgery.

The evening before your surgery:

• DO NOT drink anything after midnight, including water.

On the day of your surgery:

• Take any medicines your doctor told you to take with a small sip of water.
• You will be told when to arrive at the hospital.

After the Procedure

Most people stay in the hospital for a few days after this surgery, depending on the type of procedure they had. Most often, the recovery from this procedure is faster and with less pain than with open surgery. Also, you will most likely be able to go home sooner.

During a hospital stay, you may:

• Be in the intensive care unit (ICU), where you will be watched very closely at first
• Have a urinary catheter
• Be given medicines to thin your blood
• Be encouraged to sit on the side of your bed and then walk
• Wear special stockings to prevent blood clots in your legs
• Receive pain medicine into your veins or into the space that surrounds your spinal cord (epidural)

Outlook (Prognosis)

Recovery after endovascular repair is quick in most cases.

You will need to be watched and checked regularly to make sure your repaired aortic aneurysm is not leaking blood.

References

Braverman AC, Schemerhorn M. Diseases of the aorta. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 42.

Brinster CJ, Sternbergh WC. Endovascular aneurysm repair techniques. In: Sidawy AN, Perler BA, eds. Rutherford's Vascular Surgery and Endovascular Therapy. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 74.

Fanelli F, Falcone GM. Endovascular aortic repair. In: Mauro MA, Murphy KP, Thomson KR, Venbrux AC, Morgan RA, eds. Image-Guided Interventions. 3rd ed. Philadelphia, PA: Elsevier; 2021:chap 20.