Endovascular aortic aneurysm repair (EVAR)

Your consultant may recommend an endovascular aneurysm repair if you have an abdominal aortic aneurysm that is at risk of bursting.

You may be a candidate for EVAR if:

• You have a large aneurysm (5.5 cm or larger)
• You have a smaller aneurysm that is growing rapidly
• Your aortic aneurysm is causing symptoms such as pain and shortness of breath 
• Open surgery to repair your aneurysm is not suitable for you

There are several variations of EVAR surgery. Your consultant will decide on the best type of EVAR for you depending on where your aneurysm is located and the organs the affected artery supplies. 

Standard EVAR

During a standard EVAR procedure, a small flexible tube made of metal mesh and lined with fabric (endograft) is placed inside the weakened aorta and sealed to the aorta wall. It works by strengthening the aorta and reducing the risk of it bursting. 

Fenestrated EVAR (FEVAR) 

This type of EVAR is used to treat aneurysms that are too close to your kidneys to be repaired using a standard EVAR. It uses an endograft with carefully placed openings (fenestrations) to allow blood flow to the kidneys and other organs.

Branched EVAR (BEVAR)

This type of surgery uses an endograft with side branches to allow blood to flow to your kidneys and other organs. It is more versatile and can be used to treat more complex aneurysms than a fenestrated EVAR.

Thoracic EVAR (TEVAR)

A thoracic EVAR is used to treat an abdominal aortic aneurysm that is in the upper part of your aorta (thoracic area).

The main benefit of EVAR surgery is to stop your aneurysm from bursting. A ruptured (burst) aneurysm is a life-threatening emergency that can occur rapidly without warning and may be fatal within minutes.

EVAR has several benefits over open repair surgery including:

• No large incisions 
• A shorter hospital stay
• Less pain after surgery 
• A faster recovery time 
• A lower risk of complications such as blood loss, heart attack or death during or after surgery 

Your consultant will discuss the reasons for your EVAR surgery with you before your operation and explain the benefits of surgery as well as the risks involved. They may discuss some alternative treatments to EVAR surgery including:

Watchful waiting

If your aneurysm is small, not causing symptoms and not growing quickly, your consultant may recommend regular monitoring in the form of ultrasound scans to see if your aneurysm needs to be treated.

Lifestyle changes

If you are not a candidate for surgery, lifestyle changes such as stopping smoking, losing weight and controlling your blood pressure, cholesterol and blood sugar can reduce the risk of your aneurysm bursting.

Open repair surgery

In some cases, your consultant may recommend open surgery to repair your aneurysm. This involves making a large incision in your abdomen and replacing your aorta with a synthetic tube called a graft. Whether your consultant recommends EVAR or open surgery depends on several factors such as your age, general health, anatomy, and the type of aneurysm you have.

At your first consultation, you will typically be seen by a consultant vascular surgeon, a doctor specialising in operations involving the blood vessels.

Your consultant will ask you about your symptoms, general health and medical history and perform a physical examination. They may ask to see the results of any tests or scans you have had previously, or they may arrange them on the day. These may include:

• Blood test: To check your general health and kidney function before your surgery
• Ultrasound scan: Uses high-frequency sound waves to create images of your aorta and check for abnormalities 
• MRI or CT scan: Provides more detailed images and allows your consultant to assess the size and shape of your aneurysm

Your first appointment is important as it’s where you’ll meet your consultant, the doctor responsible for your care. Your consultant will take time to get to know you, discuss your expectations for treatment and encourage you to ask any questions you may have.

At the end of your appointment, your consultant will decide if EVAR is a suitable treatment for you based on your age, general health, and the size and location of your aneurysm. They will explain the procedure to you in detail including how to prepare, what happens during the surgery, what to expect during your recovery and any potential risks and complications.

At Circle Health Group, we want you to be as well-informed and comfortable as possible during your treatment, so please discuss any questions or concerns with your consultant during your appointment.

Your consultant will tell you everything you need to do to prepare for your endovascular aortic aneurysm repair. Instructions on how to prepare will also be in your appointment letter.

If there’s anything you’re not sure about, or if you have any questions, please contact the hospital for advice.

Pre-operative assessment 

Before your endovascular aortic aneurysm repair, you will need to attend the hospital for a pre-operative assessment to make sure you are fit for surgery. Take any medication you take regularly with you to your appointment. At the preoperative assessment, we will check your weight and blood pressure and order tests such as a blood test, chest X-ray and electrocardiogram (ECG) to evaluate your general health.

Optimise your general health

 Ensuring you are as healthy as possible before your endovascular aortic aneurysm repair will allow your procedure to go as smoothly as possible, speed up your recovery and reduce the risk of complications after your surgery.

To ensure you are as healthy as possible before your surgery:

• Stop smoking at least eight weeks before your procedure. Smoking increases the risk of complications such as breathing difficulties and infection and can impair wound healing. Your consultant can offer you advice and support with quitting smoking before your surgery.  
• Follow a healthy, nutritious diet
• Take regular exercise
• Lose weight if needed 
• Keep conditions like hypertension (high blood pressure) and diabetes well-controlled 
• Avoid alcohol for a few days before your surgery. Alcohol thins your blood and can increase the risk of bleeding during your operation.

Preparing for your recovery

 You can help your recovery go as smoothly as possible by making some preparations before your surgery. These include:

• Stock up on food and prepare a few meals in advance that you can freeze and heat up during your recovery
• Arrange to stay with a friend or relative, or have someone stay with you to help with tasks such as housework, shopping, cooking and driving for a while during your recovery 
• Arrange for child and pet care if needed 
• Keep things you use regularly such as your glasses, medications, useful telephone numbers, a book and the TV remote control within easy reach

Regular medications 

Your consultant may tell you to stop taking certain medications, such as blood thinners for a few days before your surgery. This is to minimise the risk of bleeding during and after your procedure.

Before your surgery

You’ll be admitted to hospital the day before or the morning of your EVAR surgery. Wear comfortable clothes and bring a bag containing toiletries, a change of clothes, nightwear, any medications and items such as dentures, glasses or hearing aids if you use them.

Depending on the type of anaesthetic you are having, you may not be able to eat or drink anything from midnight on the day of your surgery. Your healthcare team will give you instructions on this.

Before your surgery, you’ll need to sign a consent form to say that you agree to have the procedure and are aware of what it entails and the possible risks and complications of the surgery.

EVAR can be carried out under general anaesthetic, which means you’ll be asleep for the procedure, or you may be given an epidural or local anaesthetic, where you’ll be awake, but won’t feel any pain. If you are given local anaesthetic, you will be given medication to make you feel relaxed and sleepy during your operation. EVAR normally takes around two hours.

Once the anaesthetic has taken effect:

1. Your consultant will make a small incision in an artery in your groin
2. A thin, flexible tube called a catheter with the endograft attached is inserted into the artery and guided to the aneurysm using real-time X-ray images and contrast dye to highlight the area 
3. Once the catheter reaches the aneurysm, the endograft is opened to create new artery walls and seal the aneurysm 
4. The catheter is removed 
5. The incision is closed using a stitch or closing device

Recovering from any type of surgery is a gradual process that is different for everyone. How soon you recover depends on several factors including your age, general health, the type of procedure you had and your individual recovery process. You can help your recovery to go more smoothly by being as well informed as possible about your surgery and recovery and following your consultant’s post-operative instructions carefully. Call the hospital if you have any questions or concerns.

After your EVAR, you will be taken to the recovery room where you will be monitored closely until the effects of the anaesthetic have worn off. You will then be taken to your room.

You can start eating and drinking once the anaesthetic has worn off and will be able to sit up, get out of bed into a chair and start moving around as soon as you feel able.

You may have some pain and discomfort for a few days after your surgery. Your healthcare team will give you medication to manage this.

You can resume most normal day-to-day activities as soon as you feel well enough after your EVAR surgery. It’s normal to feel tired for a few weeks after surgery and you should return to normal activities gradually. Stop if you have pain or feel tired. Take short walks daily and gradually increase your activity level after your EVAR surgery. Avoid heavy lifting for at least six weeks after your surgery.

How many nights will I need to stay in hospital?

You can expect to spend a night or two in hospital after your endovascular aortic aneurysm repair.

Will I be able to drive home?

You will not be able to drive yourself home from hospital after your EVAR surgery. Please arrange for someone to collect you once you are discharged.

How soon can I go back to work?

How soon you can go back to work depends on your individual recovery and the type of job you do. Most people return to work within four to 12 weeks of EVAR surgery.

When can I drive?

Do not drive for at least 48 hours after your EVAR surgery, or while you are taking strong pain medication. You can drive when you can safely control your vehicle and perform an emergency stop without pain. Inform your insurance company that you have had endovascular aortic aneurysm repair surgery before driving again after your surgery.

When will I be back to normal?

You will likely feel very tired for several weeks after your EVAR surgery. Full recovery from surgery varies from person to person, but most people are recovered in between three to six weeks.

Like all surgical procedures, EVAR carries a small risk of complications.

Your consultant will explain all the possible risks and complications of endovascular aortic aneurysm repair before your procedure and answer any questions you may have. Please ensure that you are fully informed about any possible risks and complications before your procedure and are able to make an informed decision.

Possible complications of any type of surgery include:

• Adverse reactions to the anaesthetic
• Bleeding 
• Blood clots in the legs or lungs
• Wound infection
• Damage to nearby structures
• Chest infection

Possible complications specific to endovascular aortic aneurysm repair include:

• Wound infection at the incision site 
• Damage to blood vessels where the catheter was inserted 
• Haematoma (bleeding under the skin) at the incision site  
• Blood clots forming in the aneurysm 
• Kidney damage: May occur due to the contrast dye used during the procedure 
• Allergic reaction to the contrast dye 
• The graft may move or slip out of place 
• Endograft leak: This may occur if the endograft does not fully seal the aneurysm, leaving it at risk of bursting. A leak can occur months or years after EVAR surgery. Your endograft will be checked regularly during follow-up appointments and you may need further surgery if a leak is found
• Spinal cord injury: This is a very rare, but serious risk of EVAR surgery

At Circle Health Group, we have the experience and expertise to ensure the best possible care and outcome for our patients. As a patient with Circle Health Group, you can expect the highest standards of care including:

• Flexible appointment times and locations that are convenient for you
• The freedom to choose which hospital and consultant suit your needs
• Personalised, consultant-led treatment plans tailored to your individual needs
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private ensuite rooms as standard
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to see a consultant or learn more about endovascular aortic aneurysm repair, book your appointment online today or call a member of our team directly.

Endovascular aortic aneurysm repair-EVAR - Guy’s and St Thomas’ NHS Foundation Trust

Endovascular aneurysm repair (EVAR) - Wessex Vascular Network

Endovascular Repair of an Abdominal Aortic Aneurysm - Johns Hopkins Medicine

Endovascular of Abdominal Aortic Aneurysm - Penn Medicine