Endovascular Aneurysm Repair (EVAR)
This minimally invasive procedure is performed as an alternative to surgery to mend an abdominal aortic aneurysm (AAA).
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:
There are two approaches to repairing an aortic aneurysm:
1. Surgical method (open repair)
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
With 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.
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.
Other vascular procedures and treatments: