Endovascular Aneurysm Repair (EVAR) is a minimally-invasive procedure to repair an aneurysm in your aorta (the biggest artery in your body). If left untreated, the aneurysm can leak or burst to cause immediate death.
If you experience the following signs of a ruptured aortic aneurysm, seek medical attention at once:
- Sudden, severe pain
- An extreme drop in blood pressure
- Signs of shock, like passing out or dizziness, weakness
An aortic aneurysm occurs when a section of the aorta, the body’s main and biggest artery, weakens and bulges. See figure below.
The aorta transports oxygen-rich blood from the heart to other arteries that distribute blood to all the parts of the body.
An overstretched and weakened aortic wall (aneurysm) can leak, or worst case, burst. If the aneurysm bursts, it can lead to severe bleeding that can immediately cause death.
An aneurysm can develop in any section of the aorta.
If the aneurysm develops in the belly area it is called Abdominal Aortic Aneurysm or AAA, see figure below.
If the aneurysm develops in the upper body it is called Thoracic Aortic Aneurysm, see figure below. The thoracic aortic aneurysm is also called ascending or descending aortic aneurysm.
When to See a Physician
See your doctor ASAP if you have:
- A pulsating mass in your abdomen
- Abrupt weakness in the lower extremities on one side of the body
- Chest pain you have not felt before
- A cold foot or a black or blue painful toe for no apparent reason
Medical Exams and Tests
Aortic aneurysms are frequently exposed in an X-ray, ultrasound, or echocardiogram performed for other reasons.
Once in a while, an abdominal aneurysm is felt during a regular physical exam. If your doctor suspects an aneurysm, he will have you undergo further tests and exams to confirm his suspicion because it is important to:
- Locate the aneurysm
- Determine its size
- Learn how fast it is growing
- Determine if other blood vessels are involved
- Examine if there are blood clots or inflammation
Exams and tests to help determine the location, size and growth rate of an aneurysm include:
- Abdominal ultrasound
- Computed tomography (CT) and Magnetic Resonance Angiogram (MRA)
An essential objective of these tests is to calculate the risk of a possible aneurysm rupture and to compare the risk of rupture to the risks of surgery. For example, an abdominal ultrasound can closely monitor any change in the size of the aneurysm and help evaluate the risk for rupture.
Aortic Aneurysm Treatment
Aortic aneurysms that are producing symptoms or enlarging fast are viewed as a significant risk for rupture. Repair is normally advised if either of these factors occur.
In men, repair is normally advisable for AAA that are 5.5 cm or larger in diameter, causing symptoms, or are rapidly growing. In women, repair is often advisable for smaller aneurysms.
Repair of thoracic aortic aneurysms is generally advisable once they hit 5.5 cm to 6.0 cm in diameter.
If EVAR is not done, you will need routine tests to see if the aneurysm is getting bigger.
Smaller aneurysms (less than 5.5 cm in diameter) that are considered the low risk for rupture are normally treated with medicine used to treat high blood pressure, like a beta-blocker.
During the Procedure
- You will be required to take off any jewelry or other objects that may interfere with the procedure.
- You will be requested to take off your clothing. You will be provided a gown to wear instead.
- You will be requested to empty your bladder before the procedure.
- Your nurse will shave the surgical site should there be too much hair.
- An IV line will be inserted in your arm or hand.
- You will be positioned in your back on the operating table.
- Your anesthesiologist will constantly observe your heart rate, blood pressure, breathing and blood oxygen level during the surgery. By the time you are sedated, a breathing tube is usually inserted by way of your throat into your lungs and you will be plugged into a ventilator, which will breathe for you during the procedure.
- Your surgeon may opt for regional anesthesia as an alternative for general anesthesia. Regional anesthesia is anesthetic introduced in the body through an epidural (in the back) to numb the surgical site. Your surgeon can talk to you during the procedure. Your doctor will decide which type of anesthesia is best for you.
- Your surgeon will create an incision in the skin in each groin and then locate the femoral arteries. By means of fluoroscopy (a kind of X-ray that broadcasts images to an RV-like monitor), your surgeon will insert a guide wire (catheter) through the femoral artery. See figure below.
- The catheters are used to guide and deliver a stent-graft (a tube composed of fabric supported by a metal mesh called a stent) through the blood vessels to the site of the aneurysm.
- The stent-graft is in a collapsed form while being inserted and when it gets to the aneurysm, it will be expanded and attached to the wall of the aorta. As soon as the stent-graft is in place, the blood flows through the graft, avoiding the aneurysm. With time, the aneurysm generally shrinks because the blood pressure is now exerted on the wall of the graft. See Letter B, the figure above.
- Your surgeon will check for leaks using an aortogram and if no leak is confirmed, the instruments are removed.
- Your surgeon will suture the incisions and a sterile dressing will be applied.