Endovascular Aneurysm Repair (EVAR)

This minimally invasive procedure is performed as an alternative to surgery to mend an abdominal aortic aneurysm (AAA). 


What is an abdominal aortic aneurysm?

The aorta is the largest artery in the body which carries oxygenated blood from the heart to the body. The portion of artery which lies deep inside the abdomen is called the abdominal aorta. An aneurysm is a weakened, bulging area in the wall of aorta.
The aorta is under constant pressure as blood is expelled from the heart. With each heartbeat, the walls of the aorta expand and then spring back, exerting pressure on the vessel wall.

Over time the wall of the artery may become weak and the pressure from the blood pumping through causes the wall to bulge out, usually at a weak spot in the wall of the blood vessel. The weakening and the bulging of the abdominal wall artery is called Abdominal Aortic Aneurysm (AAA or “triple A”).

Abdominal aortic aneurysm develops slowly over time and the exact causes of the degenerative process remain unclear. The vast majority of aneurysms cause no noticeable symptoms, although occasionally they cause pain in the abdomen or pain in the chest, lower back (due to pressure on surrounding tissues) or in the legs (due to disturbed blood flow).

The major complication of abdominal aortic aneurysms is rupture (aneurysm bursting), which is life-threatening, as large amounts of blood spill into the abdominal cavity, and can lead to death within minutes if medical help is not sought immediately.
Should an aneurysm expand rapidly, tear, or leak, the following symptoms may develop suddenly:

  • intense and persistent abdominal or back pain that may radiate to the buttocks and legs
  • sweating and clamminess
  • dizziness
  • nausea and vomiting
  • rapid heart rate
  • shortness of breath

What is endovascular aneurysm repair?

There are two approaches to repairing an aortic aneurysm:

1. Surgical method (open repair)EVAR 2
This involves an incision into the abdomen to gain access to the aortic aneurysm. Upon gaining access, the aorta is clamped above and below the aneurysm, temporarily interrupting blood-flow.

The aneurysm sac is cut open and a long tube (graft) is sewn (sutured) into place, connecting both ends of the aorta together. The wall of the aneurysm is then wrapped around the graft and sewn into place. This procedure is done in an operating theatre while the patient is under general anaesthesia.


2. Endovascular Method

EVAR 3With this approach, a small incision is made in each groin area to access the femoral artery.

On occasions, the procedure may be performed entirely through the skin (percutaneous) without any incision. The doctor inserts a catheter or tube into the artery.

Using the X-ray control and injecting contrast, the doctor will visualise the aneurysm and plan the endovascular repair. Using specialised endovascular equipment and the X-ray images for guidance, a stent-graft (in a collapsed position) is inserted through the femoral artery and advanced up into the aorta to the site of the aneurysm.

Once in the required position, the stent graft is expanded. The graft material will bond with your arterial wall and blood will flow through the stent instead of the weakened aneurysm. Using the X-ray, the doctor checks the position of the stent graft and ensures there are no leaks. Following this, the instruments are removed.

This procedure often takes around two hours but depending on your individual circumstances, it may be shorter or longer than this. It is conducted in an angiography suite, also under general anaesthesia. It is conducted by an interventional radiologist, vascular surgeon and anaesthetist, who will be assisted by nurses and other highly trained staff.  

The benefit of the endovascular approach is reduced recovery time, particularly as there are no large incisions that need to heal. Patients are usually discharged 5 to 7 days after open repair and 1 to 2 days after endovascular repair.

Why do I need this procedure?

  • To prevent the risk of the aneurysm bursting (rupture); the larger the aneurysm, the higher the risk of it bursting.
  • To relieve symptoms caused by the bulging blood vessel.
  • To restore good blood flow.
  • Repair should be performed when the risk of rupture outweighs the risk of intervention.

How should I prepare for the procedure?

  • Fasting: You will be instructed not to eat or drink 6-12 hours before the procedure, since your procedure will be under general anaesthesia.
  • Medications: Please inform your doctor of all the medications you are taking. Your doctor may advise you to stop taking some of these temporarily a few days prior to the procedure e.g. blood thinners.
  • Allergies: Please inform Intra staff at the time of booking your procedure if you have any known history of allergies, particularly allergies to x-ray contrast and seafood.
  • Diabetes: If you are a diabetic please inform your doctor about the medication you are on. You may need to discuss your insulin dose with your specialist.

Please bring all your medications you take to the hospital with you, along with your blood test results.

On the day of your procedure, please make your way to the Mercy Hospital Reception where they will be expecting you. You will be admitted to the Mercy hospital ward and brought down to Intra for your procedure at the appropriate time.

For directions to the Mercy Hospital, click here.

What will I experience during the procedure?

  • As you will be under anaesthesia you will not feel anything during the procedure.
  • The anaesthetist will put in an intravenous canula (IV line) before the procedure and give you some medication which will make you relax and sleepy.  Then you will be given general anaesthesia.
  • Once the procedure is complete, you will be woken up and transferred to a recovery room and then later to the ward. 

What happens after the procedure?

  • After the procedure you will be taken to the recovery unit where you will be monitored until you wake up fully. Then you will be taken back to the ward.
  • You may need some pain relief to help with any discomfort as the anaesthetic wears off.
  • If you had a cutdown (surgical procedure), the length of time for the sutures to dissolve depends on the type of sutures. However, if done percutaneously, you will be able to sit up as soon as you are fully awake.  Some oozing may occur if you are on blood thinners. The nursing staff may apply compression to control any oozing.
  • Depending on the procedure, most patients are often discharged the next day. Once discharged most patients return to normal activity within 2 weeks or less.

What are the risks post EVAR?

  • Endoleaks – if the seal of the stent graft is inadequate, this would lead to blood leaking internally.
  • Stent graft migration – the graft  moves after initial placement.
  • Development of other aortic and iliac aneurysms