Endovascular Aneurysm Repair (EVAR) and Thoracic Endovascular Aortic Repair (TEVAR) are minimally invasive procedures used to treat aneurysms in the abdominal and thoracic regions of the aorta. Weaknesses and ballooning of the aortic wall (aneurysms) can lead to serious and life-threatening conditions by posing a risk of rupture. EVAR and TEVAR reduce these risks by placing a stent graft over the aneurysm, creating a new vascular pathway and removing pressure on the aneurysm. These methods, which are less invasive than open surgery, offer significant benefits such as shorter recovery time, less pain, and lower complication rates.
What is Endovascular Aneurysm Repair (EVAR)?
Endovascular aneurysm repair (EVAR) is a minimally invasive procedure used to treat abdominal aortic aneurysms. The goal of EVAR is to prevent an abdominal aortic aneurysm from rupturing, a life-threatening event. The force exerted by blood flow against a weak spot in the wall of a blood vessel (in this case, the aorta) causes the aortic walls to balloon outward, forming an aneurysm. This disrupts blood flow to your organs, which can lead to rupture. Life-threatening complications can occur within minutes.
EVAR reduces the likelihood of rupture by recoating the aneurysm with a stent graft, which reduces pressure on the aneurysm.
Who is EVAR suitable for?
Your specialist may consider EVAR if:
- You have a large aneurysm or a smaller aneurysm that is growing rapidly
- You are not suitable for open surgery with a large incision
- You have healthy blood vessel tissue near the aneurysm
What are the benefits of EVAR?
As a minimally invasive procedure, the benefits of EVAR include:
- You have a shorter hospital stay.
- You lose less blood.
- You experience less discomfort during recovery.
- You return to daily activities more quickly.
- You have a reduced risk of having a heart attack during your procedure compared to open surgery.
- The procedure takes less time than open surgery.
What are the possible risks of EVAR?
Endovascular aneurysm repair is a safe procedure with a high success rate. However, there is always the possibility of complications. These risks include:
- Blood clots
- Deep vein thrombosis (DVT)
- Blood continuing to fill the aneurysm after the procedure (endoleak)
- Heart attack
- Infection
- Kidney failure
- Bleeding
How is the EVAR procedure performed?
EVAR usually involves the following steps:-
- The procedure is performed under anesthesia.
- Your doctor uses the arteries near your groin, called the femoral arteries, to access the abdominal aortic aneurysm in your abdomen. Needles are inserted through your skin and underlying soft tissue into your femoral arteries.
- Your doctor inserts a catheter (a thin tube) containing a low-profile, expandable stent graft. The catheter is threaded through your arteries to reach the aneurysm. Real-time imaging helps control the catheter’s journey.
- When the catheter reaches the aneurysm, your doctor deploys the stent graft. This expands the stent and creates a new, fixed path for your blood to flow. The wire frame of the graft creates a tight seal that keeps the graft in place and prevents blood from entering the aneurysm.
- After the procedure is complete, the catheter is removed.
- The puncture sites are so small that stitches are usually not necessary and are usually covered with a bandage.
What is recovery like after EVAR?
Although it varies from patient to patient, the process after the procedure goes as follows:- You may need to stay in the hospital for a few days after EVAR.
- You may feel tired and need painkillers for a few days when you go home.
- You should not drive until your pain is gone.
- Most patients usually return to work within a month.
- Avoid lifting anything heavy for 4 to 6 weeks after your procedure.
When should I contact my doctor?
You should contact your doctor if you experience the following symptoms:- Symptoms of deep vein thrombosis, such as a drop in temperature, swelling, and pain in the skin of your lower extremities
- Dizziness or fainting
- Pain in your back, chest, or abdomen
- Heart palpitations
- Redness in your groin or other leg pain
What is thoracic endovascular aortic repair (TEVAR)?
Thoracic endovascular aortic repair (TEVAR) is a procedure to treat an aneurysm in the upper part of your aorta. The aorta is your body’s largest artery. An aneurysm is a weak, bulging area in the wall of your aorta. If it ruptures (ruptures), it can be fatal.
TEVAR is a minimally invasive surgery. This means it is done through a small incision (cut). The stent graft used in TEVAR helps prevent the aneurysm from rupturing.
Who might need TEVAR?
The aorta is your body’s largest artery. It carries oxygen-rich blood from your heart to the rest of your body. It travels from your heart through your chest and into your abdomen. It then branches into blood vessels that supply blood to your legs.
Sometimes, a weak area of your aorta bulges outward. This is called an aortic aneurysm. An aortic aneurysm is serious because it can rupture (dissect) or burst (rupture). The larger the aneurysm, the higher the risk of it bursting. Treatment depends on the size of the aneurysm and how quickly it is growing.
What are the risks of TEVAR?
As with any procedure, problems can occur with TEVAR. Some possible complications include:
- Infection
- Bleeding
- Injury to nearby organs
- Blood clots
- Stroke
- Risks from anesthesia
- Kidney damage from the dye used during the x-ray when the stent graft is placed
- Device or delivery failure
- Blood vessel injury
- Leaking graft
- Paralysis
- Dislocation of graft
- Loss of leg
- Need for traditional open surgery
- Continued growth of the aneurysm
- Graft infection
How do I prepare for TEVAR?
Here are some common steps you will need to follow when preparing for TEVAR:
- Tell your doctor if you are pregnant or think you may be pregnant.
- Tell your doctor if you have any allergies or sensitivities to any medications, latex, iodine, tape, contrast dyes, or anesthesia (local and general).
- Tell your doctor about all medications you are taking. This includes both over-the-counter and prescription medications. Also, tell them about vitamins, herbs, and other supplements.
- Your doctor may prescribe certain medications that you will need to take in the days leading up to your surgery. These medications can help relax your blood vessels, lower your blood pressure, and reduce the risk of your aortic aneurysm bursting.
- Tell your doctor before your surgery if you are taking blood-thinning medications. These can increase your risk of bleeding during the procedure.
- You will be told not to drink or eat anything for several hours before your surgery. This usually means not eating or drinking anything after midnight the night before your surgery.
- If you smoke, quit smoking as soon as possible before your surgery. This can increase your chances of successfully recovering from surgery. It can also improve your overall health.
How is TEVAR performed?
TEVAR is a minimally invasive procedure. This means it is done through a small incision. The procedure goes like this:
- Your patient is given anesthesia to prevent pain.
- Your surgeon makes a small incision in your groin area and arm to access your aorta. A thin tube (catheter) is inserted into the artery.
- A stent graft is attached to the end of the catheter.
- Using X-rays as a guide, your surgeon will thread the catheter with the stent graft through an artery in your groin and into the affected part of your aorta.
- After the stent graft is in place, your surgeon will expand its metal frame and secure it in place.
- The metal frame expands like a spring and holds tightly to the wall of your aorta. This provides a stable place for blood to flow. It also prevents the aneurysm from rupturing or bursting. The blood flow is now cut off from the aneurysm. This allows the aneurysm to shrink over time.
- Your surgeon removes the catheter. He or she closes the incision.
What is the recovery process like after TEVAR?
You may need to lie flat for a few hours after the procedure to prevent bleeding. You usually stay in the hospital for 3 to 4 days after surgery. Recovery from TEVAR is shorter than from traditional open surgery.
In general, you should do the following after the procedure:
- Avoid strenuous activities for at least 4 weeks.
- Check your incision for signs of infection, including redness, swelling, pain, drainage, and swelling.
- Tell your doctor if you develop a fever.
- Your doctor may order CT scans at regular intervals. These scans may include: check your graft for rupture, leakage, and other problems.
- Your doctor will tell you when to restart blood thinners to prevent blood clots.
- Follow the recommended diet plan.
- Stay on track with your follow-up appointments.
- Remember to take all your medications as prescribed.
Frequently Asked Questions About EVAR and TEVAR
What is fenestrated endovascular aneurysm repair (FEVAR)?
Fenestrated endovascular aneurysm repair (FEVAR) is a special EVAR technique that repairs complex aneurysms. Your abdominal aorta is shaped like a tree trunk with many branches coming out of it. These branches are the arteries that carry blood to the organs in your abdomen. If an aneurysm occurs near one of these branching points, it is more difficult to treat. That’s where FEVAR comes in.
FEVAR uses a fenestrated stent graft, which is a graft with small openings. These openings lead to additional stent grafts that go to the branching arteries. This special device fits into the tree-like structure of your aorta and its branches.
Your doctor will decide which procedure you need based on where your aneurysm is located.
What is the difference between EVAR and TEVAR?
EVAR treats aneurysms in your abdomen (abdominal), while TEVAR treats aneurysms in your ribcage. TEVAR is particularly suitable for aneurysms in your descending aorta, the part that runs from your chest to your abdomen. Aneurysms in your aortic root or ascending aorta, which are very close to your heart, usually require open surgery.
Who is not suitable for EVAR?
The feasibility of EVAR depends on the patient’s anatomy. Key anatomical considerations include the length, shape and angulation of the infrarenal neck; the condition of the common iliac arteries; and the size, tortuosity or disease of the ilio-femoral access vessels.
Who is not eligible for TEVAR?
Unfavorable anatomy is the primary contraindication to TEVAR, including inadequate proximal or distal sealing zones, tortuosity, lack of vascular access options, or excessive aortic diameter. Placement in infected areas should also be avoided, although some small studies have shown that TEVAR may be useful as a time-saving measure in contaminated areas such as aortoesophageal fistulas.
Who is eligible for TEVAR?
TEVAR may be a good option for you if you have a thoracic aortic aneurysm, type B aortic dissection, or another aortic condition. TEVAR is a minimally invasive procedure that can repair a weakened section of the aorta and prevent potentially life-threatening complications.