Endovascular Abdominal Aortic Aneurysm Repair (EVAR)

A stent graft is a tube made of strong fabric supported by a metal skeleton called a stent. It is designed to seal tightly with your artery above and below the aneurysm. The blood then passes through the stent graft without pushing on the weakened bulge that is the aneurysm. Aortic aneurysms vary in shape and not all aneurysms can be treated with a stent graft. However, if the shape of the aneurysm is amenable to endovascular repair, this is generally preferred because of its less invasive nature, especially in patients who are older or have other conditions that increase the risk of surgery.

Preparation for Surgery

Tests required before the operation include blood tests, chest X-ray, and a CT scan of the abdomen and pelvis. You will need to go to the Pre-Surgery Clinic at Trillium West Toronto and meet with an anesthetist before the operation. Ideally you should attempt to complete all these tests before the visit so the anesthetist can review the results with you. You also need to have a checkup with your family physician prior to surgery. You should take your surgical package to all the appointments.

What does the operation consist of?

The operation is usually done under spinal anesthesia, which is an injection in your back that numbs your lower body. Small incisions are made at the groin to access blood vessels. Then long, thin tubes called catheters are threaded through the blood vessels to the part of the aorta needing repair. The stent graft is implanted into the aorta using live x-rays. You may feel a warm sensation as dye is injected and you may be asked to hold your breath for a few seconds during the procedure.

What happens after surgery?

You will be cared for on the surgery ward. You will have an intravenous tube and bladder catheter that will be removed the next morning. You are allowed to resume a normal diet immediately and start walking as soon as the spinal anesthetic wears out. Most patients are discharged home the next morning.

Recovery at home

You will have a small incision in each groin and absorbable sutures. You may shower the second day after surgery. The small paper strips on the incisions can be removed after 7 days. You may resume normal activities immediately. You should regain your usual energy level and appetite within 2-3 weeks. You may resume driving and sexual activity as soon as the discomfort from the incision subsides. Your surgeon will arrange for you to have a CT scan one month after surgery. 

Complications

Fever occurs commonly after endovascular stent grafting and can last up to 10 days. It is usually treated with aspirin or ibuprofen. The risk of major complications with endovascular repair is about 1%. This risk must be balanced against the risk of aneurysm rupture. Rare early complications include death, bleeding, problems with the circulation to the kidneys, legs and intestines and paralysis. Possible late complications include obstruction of the blood flow through the stent and leakage of blood around the stent into the aneurysm sac (endoleak). This can lead to aneurysm enlargement and even delayed rupture. For this reason you will need to have life-long regular follow-up to ensure your stent graft if functioning well. This may include having ultrasound or CT scans of your abdomen at regular intervals.