EVAR at TX Hospitals: Minimally Invasive Aneurysm Repair
Endovascular Aneurysm Repair (EVAR) is a minimally invasive procedure used to treat abdominal aortic aneurysms (AAA). During the procedure, a stent-graft is placed inside the aorta through small incisions in the groin. This stent-graft acts as a protective barrier to prevent the aneurysm from rupturing by redirecting blood flow, thus strengthening the weakened aortic wall. EVAR reduces the need for open surgery, offers faster recovery, and typically results in fewer complications compared to traditional methods.
Symptoms of AAA may include:
- Sudden onset of severe back, abdominal, or “loin-to-groin” pain
- Pain in the chest, abdomen, lower back, or just above the kidneys, often spreading to the groin, buttocks, and legs. The pain can range from mild to deep or throbbing, lasting for hours or days.
- A pulsating sensation in the belly
- When blood clots form in the aneurysm, they may block blood flow to the legs or feet, leading to cold feet or painful, discolored toes
- Fever or weight loss, especially in the case of an inflammatory aortic aneurysm
- EVAR is an effective treatment for these symptoms, preventing aneurysm rupture while minimizing surgical risks and promoting quicker recovery.
When EVAR is Performed?
EVAR is performed in the following situations:
- Large or rapidly growing aneurysms: Typically when the abdominal aortic aneurysm (AAA) exceeds 5-5.5 cm in diameter or is growing quickly.
- High risk of rupture: If the aneurysm is at significant risk of leaking, splitting, or bursting.
- Ineligibility for open surgery: Patients who cannot undergo open surgery due to higher surgical risks or underlying conditions.
- Healthy surrounding tissue: When there is sufficient healthy blood vessel tissue around the aneurysm to securely attach the stent-graft.
- Specific aneurysm location: Aneurysms below the renal arteries or those in locations suitable for stent-graft placement.
Types of EVAR Procedures
Traditional EVAR:
- Standard procedure for aneurysms located below the renal arteries.
- Involves placing a stent-graft inside the aneurysm to redirect blood flow and reduce pressure.
Fenestrated EVAR (FEVAR):
- Used for aneurysms near or involving the renal arteries.
- The stent-graft has fenestrations (openings) to allow blood flow to the renal arteries and other branch vessels.
Branched EVAR (BEVAR):
- Designed for aneurysms that involve major branch vessels of the aorta (e.g., arteries to the kidneys or other organs).
- Includes stent-grafts with side branches for continued blood flow to these arteries.
Thoracic EVAR (TEVAR):
- Used to treat thoracic aortic aneurysms in the chest.
- Can also address aneurysms extending into both the thoracic and abdominal regions.
Branched Iliac EVAR (IBE):
- Targets iliac aneurysms or aneurysms involving the iliac arteries.
- Self-expandable stent-grafts connect the main aortic graft to the iliac arteries’ branches.
Preparation Before EVAR Procedure:
To prepare for Endovascular Aneurysm Repair (EVAR), provide accurate and detailed information about your medical history and current medications, including over-the-counter drugs and supplements. If you are taking blood-thinning medications, you may ask you to temporarily stop them to reduce the risk of bleeding. Pre-procedure tests such as blood tests, ECG, echocardiography, CT scan, or angiography may be required to assess your condition and plan the surgery. Additionally, you will need to fast for at least 8 hours before the procedure as directed by your medical team.
Procedure:
Endovascular Aneurysm Repair (EVAR) is a minimally invasive procedure performed under general or regional anesthesia. Small incisions are made in the groin to access the femoral arteries, where a catheter is inserted and guided to the aneurysm using real-time imaging. A stent graft, a mesh-like metal tube covered with polyester fabric, is delivered through the catheter to the aneurysm site. Once positioned, the stent graft is expanded and secured to create a stable blood flow path, bypassing the weakened aortic wall and preventing rupture. The catheter is then removed, and the incisions are closed, typically with dissolvable stitches.
Post-Procedure for EVAR Recovery
Hospital Stay and Monitoring: Patients typically stay in the hospital for 1-2 days for close monitoring of vital signs, including heart rate, blood pressure, and oxygen levels.
Pain Management and Mobility:
- Pain medications will be provided as needed to ensure comfort.
- Gradual activity will be encouraged, starting with assisted walking to improve circulation and reduce the risk of complications.
- Avoid heavy lifting or strenuous activities for 4-6 weeks.
Diet and Hydration: Have plenty of water and maintain healthy rich diet of whole grains,lean proteins, low sodium foods , healthy fats to support healing and overall health.
lifestyle changes:
- Fatigue and mild discomfort are common for 1-2 weeks post-procedure.
- Ensure the surgical site remains clean and dry
- Avoid driving while taking pain medications.
- Moderate physical activity such as walking is recommended.
Medications and Follow-Up Care:
- Adhere to the medications and dont miss the daily doses.
- Routine follow-up visits and imaging studies (e.g., CT scans, ultrasounds) will be scheduled to monitor the stent-graft and ensure proper healing.
When to call for doctor:
If you experience any signs and symptoms:
- Bleeding from the incision site that doesn’t stop with pressure.
- Redness, swelling, discharge, or increasing pain at the wound.
- Fever, chills, or other signs of infection.
- Numbness, weakness, or colour changes in the limbs.
- Persistent or worsening abdominal or chest pain.
Complications of EVAR
- Blood Clots: Risk of DVT or pulmonary embolism.
- Endoleak: Blood leaks into the aneurysm after the procedure.
- Stent Migration: The stent may move out of position.
- Heart Attack: Rare risk of cardiovascular issues.
- Kidney Failure: Possible damage from contrast dye.
- Infection: Risk of infection at the incision site or in the graft.
- Bleeding: Excessive bleeding during or after the procedure.
- Limb Ischemia: Reduced blood flow to the legs or feet.
- Spinal Cord Injury: A rare but serious risk.
Benefits of EVAR
- Minimally Invasive: Smaller incisions, faster recovery.
- Lower Risk: Less chance of complications compared to open surgery.
- Quick Recovery: Short hospital stay, back to normal activities in 4-6 weeks.
- Reduced Pain: Less pain after surgery.
- Effective Repair: Prevents aneurysm rupture with a high success rate.
- Lower Mortality: Safer than open surgery with fewer risks.
FAQ's
EVAR is a minimally invasive procedure to treat abdominal aortic aneurysms (AAA) by placing a stent-graft inside the aorta to prevent rupture.
Symptoms include severe back or abdominal pain, pulsating belly, chest or lower back pain, cold or painful toes, and fever or weight loss in some cases.
EVAR is performed for large, rapidly growing aneurysms, those at risk of rupture, or if open surgery is not an option.
Benefits include smaller incisions, quicker recovery, lower risk of complications, and effective prevention of aneurysm rupture.
Risks include blood clots, infections, endoleaks, stent migration, bleeding, and rare complications like spinal cord injury or kidney issues.