Mr Michael E Gaunt - Consultant Vascular Surgeon

Also see the page on open repair of abdominal aorticaneurysms.

EVAR is a minimally invasive method for the repair of thoracic and abdominal aortic aneurysms. Instead of an incision in the abdomen and/or chest, incisions are made in both groins and stenting devices are inserted through the femoral arteries into the aorta. Once in position the stents are expanded inside the aorta to repair it.

Admission - Depending on arragements you will be admitted to the ward on the day of the procedure or the day before. The ward nursing staff will show you to your bed and help you to settle in. They will explain the procedures for theatre and show you where every thing is. You should not have anything to eat or drink for six hours before the operation. Your surgeon will visit you before the operation and explain the procedure again and answer any questions.

Anaesthesia - Generally the operation is performed under general anaesthesia but sometimes the operation is performed under local anaesthetic or epidural. Your anaesthetist will discuss the anaesthetic technique with you before the operation.

Surgery - an incision will be made in each groin and the femoral arteries exposed. Specialised wires and catheters will be inserted through the femoral arteries into the aorta. X-rays will be performed and intravenous dye injected to determine the correct position of the stent. The stent is expanded inside the aorta to repair it. Usually a number of stents are inserted to repair the aorta and the iliac arteries.

Sometimes the stenting procedure is combined with an operation to repair more complex aneurysms and there are lots of variations. Your surgeon will explain to you which procedure is planned for you.

After the operation - You will be monitored in the theatre recovery area for 1-2 hours. The nurse looking after you will make careful measurements of your pulse, blood pressure and breathing. You may find there is a urinary catheter inserted into your bladder to allow urine to drain into a bag. This is a temporary measure to prevent retention of urine which can cause your blood pressure to become unstable. After a few hours if all is well you will be allowed to eat and drink.

One to two days after the operation all monitors, catheters and drains are removed and you can walk around the ward.

Discharge from hospital - you will be visited each day by the surgical team who answer any questions you might have about your surgery. Your progress will be assessed and the appropriate time for your discharge from hospital will be decided. Most people are discharged 2-3 days after the operation.

Once at home - You will probably need 2-4 weeks off work, returning when you feel comfortable. Avoid driving for at least 2-4 weeks until you regain full painfree movement. Genetle exercise is good e.g. walking but avoid any heavy lifting or straining for as long as possible.

Complications of EVAR - the complications of EVAR are similar to open aneurysm repair in that the function major organs , e.g. heart, lungs and kidneys may be affected. However, it is generally considered to be less common with EVAR than with open repair.

The incisions in the groins may bleed resulting in haemorrhage, false aneurysm and/or bruising. Thre groin may develop swelling caused by excess tissue fluid- seromas- which may become infected and need drainage and/or antibiotics.

Long term Complications - Once a stent is inserted into the aorta it needs to be monitored every three months for the first year and they yearly thereafter. This is because problems can develop with the stent in about 40% of cases. If detected early enough they can normally be corrected before they cause any harm.

The practice of medicine and surgery is not an exact science and reputable practitioners cannot properly guarantee results either expressed or implied. These procedures are highly advanced and discussion about them (including risks and benefits) should be with your specialist.