Endovascular Aneurysm Repair (EVAR)
Endovascular aneurysm repair or EVAR is a procedure for treating an aneurysm or abnormal enlargement of the abdominal aorta. When the abdominal aorta gets enlarged, there are generally two ways to perform surgery. It might be performed through an open incision or in a minimally-invasive procedure known as endovascular aneurysm repair.
This technique has an advantage, which is that there is no abdominal surgery. This makes this technique safer than the traditional open surgery and you also need to spend lesser time at a hospital.
The largest artery in your body is the aorta. It helps to transport blood from your heart to various other body parts. When the aorta runs through the chest, it is known as thoracic aorta and when it reaches the abdomen, it is called as the abdominal aorta. This aorta helps supply blood to the lower parts of your body. The normal diameter of this aorta is around 1 inch or 2 cm. However, when it gets weakened or stretched, then it might expand or bulge. This condition is known as abdominal aortic aneurysm. When this aneurysm is over 5.5 cm, this increases the risk of a rupture and your doctor might consider a surgery.
First your doctor will explain you how the procedure is done and you will have the opportunity to ask any questions that you might have. Your doctor might need to examine your medical history to ensure that you are in good health. You might also need to undergo blood tests as well as other diagnostic tests.
You will be asked to fast for a minimum of eight hours before your procedure, generally after midnight.
You should notify your doctor if you are pregnant, or if you think you might be. You should also let your doctor know about any medications that you are taking.
If you have a history of bleeding disorders, or if you are having anticoagulant medications, then it might be necessary for you to stop taking these medications. If you smoke, you will need to stop it as soon you can before the procedure. Smoking can interfere with your chances of having a successful recovery from the surgery and to improve your overall health status.
The areas of your surgical site might require shaving before the procedure.
Procedures might vary depending on your condition, as well as on the skills and experience of your doctor.
First you will need to lie on your back on the procedure table. Then your heart rate will be continuously monitored. Once you are sedated with anesthesia, a breathing tube is likely to be inserted through your lungs. You will be connected to a ventilator, which will help you in breathing throughout the surgery.
Your surgeon will make an incision in each groin, to expose the femoral arteries. Using a method known as fluoroscopy, he will be inserting a needle into the femoral artery through which a guidewire is going to be passed and advanced to the aneurysm site.
Then he/she will inject contrast dye to visualize the position of the aneurysm and its adjacent blood vessels. After this, he/she will use special endovascular instruments and X-ray images for guidance. A stent-graft is then going to be inserted through the femoral artery, and will be advanced up into the aorta to the site of the aneurysm. It will be expanded and attached to the wall of the aorta.
An aortogram is going to be done to check for an endoleak, i.e. blood leaking out into the aneurysm sac of the stent graft. Once it is determined, that there is no leak, the instruments are going to be removed.
Then the incisions are going to be sutured back together, and the doctor will apply a bandage or a dressing.
Depending on your condition, you may or may not be sent to the ICU. However, it is likely that you are going to be taken to a post-anesthesia care unit. You are going to be connected to monitors that will be constantly displaying your ECG tracing, blood pressure, breathing rate, your oxygen level as well as other pressure readings.
If you experience any pain, you will receive the appropriate medicines.
Slowly, you will be able to increase your daily activities gradually.
Once you are home, make sure that you keep the surgical site clean and dry. You will receive instructions from your doctor regarding this. If the sutures or surgical staples were not removed before you left the hospital, they will be removed during a follow-up office visit.
You should not drive unless your doctor tells you to.
If you experience fevers or chills, redness, swelling or bleeding at the incision site, or increase in pain around the incision site, then you need to notify your doctor soon.
There is a small risk that you might experience any of the following after the surgery:
- Heart attack
- Kidney failure
- Chest problem
- Loss of circulation in your legs or bowel
- Infection in the graft which was used to replace your aorta
A small percentage of men might also have difficulty in sustaining an erection after the surgery. If you experience you should inform your doctor, as there are treatments that are able to help.
Another recognized risk is deep vein thrombosis, which most patients can experience during the stay at the hospital. Your surgeon can recommend a treatment to prevent this.
It is best to discuss all risks and possible complications with your surgeon, before you undergo the surgery.