Aortic aneurysm repair - endovascular

  • Definition
    • Endovascular abdominal aortic aneurysm 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 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.

      • Your doctor will make a small surgical cut near the groin, to find the femoral artery. Then your doctor will insert a stent (a metal coil) and a manmade (synthetic) graft through the cut into the artery.
      • The doctor uses x-rays to guide the stent graft up into your aorta, to where the aneurysm is located. The doctor will open the stent using a spring-like mechanism and attach it to the walls of the aorta. Your aneurysm will eventually shrink around it.
      • The doctor will then use x-rays again to make sure the stent is in the right place and your aneurysm is not bleeding inside your body.
  • Why the Procedure Is Performed
    • Endovascular aortic repair is done because your aneurysm is very large, growing quickly, or is leaking or bleeding.

      You may have an abdominal aortic aneurysm that is not causing any symptoms or problems. Your doctor may have found out about this problem when you had an ultrasound or CT scan for another reason. There is a risk that this aneurysm may open up (rupture) if you do not have surgery to repair it. However, surgery to repair the aneurysm may also be risky. In such cases, endovascular repair is an option.

      You and your doctor must decide whether the risk of having this surgery is smaller than the risk of rupture if you do not have surgery to repair the problem. The doctor 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 1/2 centimeter over the last 6 to 12 months)

      Endovascular repair has a lower risk of complications compared to open surgery. Your doctor is more likely to suggest this type of repair if you have other serious medical problems or are elderly.

  • Risks
    • Risks for any surgery are:

      Risks for 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 open surgery
      • The stent slips
  • Before the Procedure
    • Your health care 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 naprosyn (Aleve, Naproxen).
      • 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 3 to 5 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. Diseases of the aorta. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 57.

      Lederle FA, Freischlag JA, Kyriakides TC, Matsumura JS, Padberg FT Jr, Kohler TR, et al. Long-term comparison of endovascular and open repair of abdominal aortic aneurysm. N Engl J Med. 2012 Nov 22;367(21):1988-97. PMID: 23171095

      Tracci MC, Cherry JR KJ. The Aorta. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 62.