What is Endovascular Aneurysm Repair (EVAR)?
Endovascular Aneurysm Repair (EVAR) is an advancement in the field of vascular surgery, offering a minimally invasive solution to manage aortic aneurysms.
An aortic aneurysm is an abnormal swelling of the aorta, the major blood vessel carrying blood from the heart and distributing blood to all parts of the body via various branches. The abnormal swelling is due to development of areas of weakness in the vessel wall. Untreated, these aneurysms can continue to grow and carry a risk of rupture which can be catastrophic and life threatening
Endovascular Aneurysm Repair, abbreviated as EVAR, is a medical procedure that pertains to the treatment of aortic aneurysms.
This minimally invasive technique performed by Vascular surgeons and Interventional Radiologists is designed to reinforce these weakened arterial walls by inserting a stent-graft into the aorta. The stent-graft not only diverts blood flow away from the aneurysm but also promotes overall aortic stability, mitigating the risk of rupture and associated complications.
Why Would a Doctor Refer Me to Have This Procedure?
Aortic aneurysms can be asymptomatic, but they pose a significant threat due to their potential to rupture, which can be life-threatening. Only 1 in 5 will survive a rupture, which can be fatal within hours.
When a doctor detects the presence of an aortic aneurysm through imaging studies or clinical evaluation, they may refer a patient to an interventional radiologist for EVAR to prevent aneurysm expansion, rupture, and any related complications.
Wondering If You Qualify for Endovascular Aneurysm Repair?
Who Qualifies for Endovascular Aneurysm Repair?
Majority of patients with aortic aneurysms are suitable for EVAR. The qualifying criteria includes factors like the size and location of the aneurysm, your overall health, and the potential risks associated with surgical intervention.
Aortic aneurysms of a certain size, particularly those exceeding a predetermined threshold, may necessitate treatment. There are also patient-specific factors, including age and medical history, that can also play a pivotal role in determining candidacy.
Preparation for the Procedure
The preparation for EVAR encompasses a series of steps.
- Patients will undergo comprehensive evaluations, including medical history reviews, imaging studies, and laboratory tests.
- Discussion with the healthcare team is essential to address any existing allergies, medications, or medical conditions.
- Preparatory measures may also include fasting before the procedure, adjustments to certain medications, and the provision of detailed guidelines from the healthcare team.
What Happens During the Procedure?
Endovascular Aneurysm Repair is an endovascular procedure, meaning it is conducted inside the blood vessels. Typically performed under general anaesthesia, EVAR begins with a small incision to access the femoral arteries. In selected patients, the procedure can be performed as “pin hole surgery” with only a small incision (typically less than 1cm) visible. Through these access points, a catheter is threaded to the site of the aneurysm. The stent-graft is then deployed, securing the weakened aortic wall. The procedure is closely monitored using advanced imaging techniques to ensure accurate placement and minimal disruption.
What Is the Recovery Normally Like?
Because this is a minimally invasive procedure, the recovery following EVAR is typically quicker than traditional open surgical methods. Patients will often spend a brief period in postoperative care for monitoring and observation.
Immediately following this procedure, you could experience mild discomfort at the incision sites. Gradually, you will be able to resume your daily activities following medical approval. Engaging in physical activity is usually encouraged to expedite the recovery process but would be specifically discussed and determined by your doctor.
What are the risks?
While EVAR is regarded as a minimally invasive procedure with relatively low risks, it is not devoid of potential complications. Risks can include complications at the access sites, endoleaks (persistent blood flow into the aneurysm sac), device migration, and renal complications. Treatment of more complex aneurysms located close to/involving major branches of the aorta are associated with additional potential complications including lower limb weakness/paralysis. Thorough evaluation and strict adherence to post-procedural instructions are essential in mitigating these risks. Overall, the risks of the procedure including complex aneurysms is significantly less than open surgery. The procedure is only offered to patients where the potential benefits outweigh the risks.
What are the benefits?
Endovascular Aneurysm Repair offers an array of benefits, notably a reduced risk of aneurysm rupture and related complications. EVAR typically leads to shorter hospital stays, quicker recovery, and diminished postoperative discomfort when compared to open surgical approaches. By reinforcing the aortic wall and diverting blood flow away from the aneurysm, EVAR provides a long-term solution to safeguard vascular health.
WHEN CAN I EXPECT THE RESULTS OF MY PROCEDURE?
The timeline for post-procedure outcomes in EVAR can vary among patients. While some may experience immediate relief from the risks posed by the aneurysm, it may take some time for the aorta to fully stabilise. You can expect regular follow-up appointments and imaging studies to monitor the progress of the repaired aneurysm.
Endovascular Aneurysm Repair (EVAR) is a procedure offering a minimally invasive approach to address aortic aneurysms and prevent the potentially life-threatening consequences of rupture. It is imperative to engage in open dialogue with your healthcare professionals to make informed decisions about the suitability of EVAR and its potential benefits.
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