Overview
Endovascular stent grafting, or endovascular aneurysm repair (EVAR), is a surgical procedure done inside of the aorta using a thin tube called a delivery catheter. Endovascular surgery requires only two small incisions in the area of the groin.
In many cases, the surgery takes 2 to 4 hours to complete, which is much shorter than open surgery aneurysm repair.1
The following information describes what can be expected at each stage of the endovascular stent graft procedure.
Before the Procedure
Prior to the procedure, a number of diagnostic tests will be performed. These diagnostic tests allow the doctor to visualise the abdominal aneurysm and the surrounding area, and help the surgeon decide what type of stent graft is most appropriate. During this time, the doctor will discuss the surgery, and answer any questions.
During the Procedure
To prepare the patient for the procedure, the groin area where the delivery catheter and stent are introduced will be cleaned and shaved. Local anaesthetic will be administered, to numb the area of the surgery, or general anaesthesia to induce sleep during the surgery.
After the anaesthesia has taken effect, the surgeon will make a small incision in both of the thighs. Using x-rays to see the exact location of the aneurysm, the surgeon will guide the delivery catheter through the large vessel in the thigh (iliac vessel) to the aneurysm site in the abdomen.
The stent graft is slowly released from the delivery catheter into the aorta. As the stent graft is released, it expands to the proper size so that it fits into the aorta both above and below the aneurysm.
The delivery catheter is then withdrawn and removed, leaving the stent graft within the aorta. Depending on the shape and size of the aortic aneurysm, additional stent grafts may be placed to ensure that the aneurysm is completely excluded from normal blood flow.
X-rays and ultrasound imaging help the doctor make sure that the stent graft is properly placed and excluding blood flow to the abdominal aortic aneurysm.
After the Procedure
After surgery, careful monitoring is conducted by the surgical team. Surgery may require lying flat for 4-6 hours to allow leg wounds to heal, and there may be some discomfort.
Side effects experienced may be swelling of the upper thigh, numbness of the legs, nausea, vomiting, leg pain or throbbing, malaise, lack of appetite, fever, and/or absence of bowel movement for one to three days.
References
1
Vascular societies https://www.vascularsociety.org.uk/patients/procedures/2/endovascular_aneurysm_repair_evar