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Endovascular aneurysm repair (EVAR) is an important advance in the treatment of abdominal aortic aneurysm(AAA). EVAR is performed by inserting graft components folded and compressed within a delivery sheath through the lumen of an access vessel, usually the common femoral artery.
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What is endovascular repair of an abdominal aortic aneurysm?

Endovascular repair is a type of treatment for an abdominal aortic aneurysm, or AAA. An AAA is a bulge in the wall of the large artery below your heart. The large artery is called the aorta. The bulge is caused by a weak section in the artery wall. The bulge is at risk of tearing. During the procedure, the weak section of the aorta is treated to prevent it from tearing.

Your arteries are the blood vessels that deliver oxygen-rich blood and nutrients to the tissues of your body. The aorta is the largest artery in the body. It leads from your heart down through the inside of your chest and belly (abdomen). The section that goes through the abdomen is called the abdominal aorta. The walls of your aorta are normally thick enough to handle the force of the blood pressure from the heart. But some health problems can damage the walls of the aorta. This can cause a balloon-like bulge in the wall of the aorta called an aneurysm. In some cases, an aneurysm can start to split or even burst. This can often cause death. An aneurysm may also start to split along the inside of the aorta wall. This is known as aortic dissection. It can also often cause death.

Many factors can damage the walls of your aorta and cause an aortic aneurysm, such as:

  • High blood pressure

  • Smoking

  • Atherosclerosis

  • Injury

  • Certain infections (such as untreated syphilis)

  • Certain genetic conditions (such as Marfan syndrome)

  • Aging

  • High blood pressure

Endovascular repair is a minimally invasive procedure. This means it is done with a small cut (incision). It is often done under general anesthesia, so you sleep through the procedure. During the procedure, a surgeon makes an incision through an artery in your groin. A thin, flexible tube (catheter) is threaded up through the artery and to the site of the aortic aneurysm. A stent graft is sent along the catheter to the aneurysm. The stent graft is a tube made of a thin metal mesh (the stent), covered with a thin polyester fabric (the graft). This stent graft is opened inside the aorta and fastened in place. The stent graft stays in place, and blood flows through it. It protects that part of the aorta, and prevents the aneurysm from bursting.

Why might I need endovascular repair of an abdominal aortic aneurysm?

You may need this procedure if your AAA is over 5 centimeters (cm) or getting larger. You may also need this procedure if your AAA is at risk of splitting or bursting.

A small abdominal aortic aneurysm may not need a medical procedure. This is the case if an aneurysm is less than 5 cm and isn’t getting larger. Smaller aneurysms are less likely to burst or split. Your healthcare provider will likely closely watch your health and give medicines to lower the risk of aneurysm rupture.

Open surgery and endovascular repair are the two main types of surgery to repair an aneurysm. During open surgery, a surgeon makes a large cut in your belly or chest. The surgeon then replaces the damaged part of the aorta with a graft.

Endovascular repair uses a much smaller incision than open surgery. Because of this, it has a lower risk of complications. It may benefit older adults who have a higher risk of complications. It can also lead to faster recovery. Not all aneurysms can be treated with endovascular repair. Your provider will talk with you about the treatment that will work best for you.

What are the risks of endovascular repair of an abdominal aortic aneurysm?

Every procedure has some risks. The risks of this procedure include:

  • Heavy bleeding at the insertion site

  • Blood that still flows through the aneurysm bulge

  • A graft that moves, bends, or comes loose

  • Infection

  • Heart attack

  • Reaction to anesthesia

  • Reduced blood flow to the legs, intestines, or kidneys

  • Pressure in the abdomen that can damage organs (abdominal compartment syndrome)

  • The need to change to open surgery during the procedure

Your risks may vary depending on your age, your overall health, and the size and location of your aneurysm. Talk with your healthcare provider to learn which risks apply to you. Tell your provider about any questions or concerns you have.

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