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by Neff DM
(Minimally Invasive Repair of Abdominal Aortic Aneurysm; EVAR)

Definition

Endovascular repair of abdominal aortic aneurysm (EVAR) is a procedure to put a stent in the abdominal aorta. The aorta is the largest artery in the body. The abdominal aorta is below the chest and above the waist. It carries blood to the abdomen, pelvis, and legs.

Abdominal Aortic Aneurysm
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Reasons for Procedure

EVAR is often done to repair an abdominal aortic aneurysm (AAA). An AAA is when the walls of the aorta weaken and bulge in one area. This procedure helps strengthen the area.

Possible Complications

Problems are rare, but all procedures have some risk. The doctor will go over some problems that could happen, such as:

  • Excess bleeding
  • Infection
  • Problems from anesthesia
  • Damage to other organs or structures
  • Leaking of blood at the graft
  • Heart attack
  • Blood clots

Things that may raise the risk of problems are:

  • Smoking
  • Drinking alcohol
  • Chronic diseases such as diabetes or obesity

What to Expect

Prior to Procedure

The care team may meet with you to talk about:

  • Anesthesia options
  • Any allergies you may have
  • Current medicines, herbs, and supplements that you take and whether you need to stop taking them before surgery
  • Fasting before surgery, such as avoiding food or drink after midnight the night before
  • Whether you need a ride to and from the procedure
  • Tests that will need to be done before surgery

Anesthesia

The doctor may give:

Description of the Procedure

Small incisions will be made in both sides of the groin. Thin tubes will be inserted into the blood vessels. The tubes will be threaded up toward the aneurysm. Contrast dye will be injected through the tubes. The dye will help the doctor see the area better. A stent graft will be guided to the site. The graft will be placed into the weakened area. It will extend into both pelvic arteries. X-rays will be used to guide each step. Once the graft is in place, the tubes will be removed. The incisions will be closed. Bandages will be placed over the sites.

How Long Will It Take?

About 2 to 3 hours

Will It Hurt?

There will be some discomfort from the groin incisions. Medicine will help.

Average Hospital Stay

The usual length of stay is 1 to 2 days. If you have problems, you may need to stay longer..

Post-procedure Care

At the Hospital

After the procedure, the staff may:

  • Give you pain medicine
  • Have you gradually get up and move around

During your stay, the hospital staff will take steps to lower your risk of infection such as:

  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered

There are also steps you can take to lower your risk of infection such as:

  • Washing your hands often and reminding visitors and staff to do the same
  • Reminding staff to wear gloves or masks
  • Not letting others touch your incisions
At Home

Recovery takes about 2 to 4 weeks.

Call Your Doctor

Call your doctor if you are not getting better or you have:

  • Redness, swelling, excess bleeding, or discharge from the incision
  • Signs of infection, such as fever and chills
  • New belly pain, back pain, or loose stools
  • Any change of color or sensation in your legs or feet
  • Problems passing urine
  • Lasting nausea or vomiting
  • Confusion, lasting sadness, or tiredness
  • Cough

Call for medical help or go to the emergency room right away if you have:

  • Problems breathing
  • Chest pain

If you think you have an emergency, call for medical help right away.

RESOURCES

American Heart Association  http://www.heart.org 

Society for Vascular Surgery  https://vascular.org 

CANADIAN RESOURCES

Heart and Stroke Foundation of Canada  http://www.heartandstroke.ca 

University of Ottawa Heart Institute  https://www.ottawaheart.ca 

References

Abdominal aortic aneurysm (AAA). EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/abdominal-aortic-aneurysm-aaa. Accessed July 20, 2021.

Abdul Jabbar A, Chanda A, et al. Percutaneous endovascular abdominal aneurysm repair: State-of-the art. Catheter Cardiovasc Interv. 2020;95(4):767-782.

Endovascular repair of abdominal aortic aneurysms. Society for Vascular Surgery website. Available at: https://vascular.org/patient-resources/vascular-treatments/endovascular-repair-abdominal-aortic-aneurysms. Accessed July 21, 2021.

Endovascular repair of thoracic aortic aneurysms. Cleveland Clinic website. Available at: https://my.clevelandclinic.org/health/treatments/16962-endovascular-repair-of-thoracic-aortic-aneurysms. Accessed July 21, 2021.

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