Endovascular Aneurysm Repair (EVAR)

What is endovascular aneurysm repair (EVAR)?

Endovascular aneurysm repair (EVAR) is a procedure to fix an aortic aneurysm in the abdomen. It's called endovascular because a doctor repairs the aneurysm from the inside of the damaged blood vessel (the aorta). This is a minimally invasive procedure. Local or general anesthesia might be used but it is not a surgery.

What happens during an EVAR prcedure?

The doctor will make one or two cuts (incisions) in the groin area. Small flexible tubes, called catheters, are inserted into arteries in the groin area. The doctor puts dye into the arteries. The dye will make your aorta show up on X-ray pictures during the procedure.

The doctor uses the catheters to move a man-made tube, called a stent graft, through the arteries until it reaches the aorta. The doctor expands the graft inside of the aneurysm. Then the doctor attaches the graft to the blood vessel. When the graft is in place, the doctor will take out the catheters and the wires. He or she will use stitches to close the incisions in the groin area. After the procedure, blood passes through the graft in the aorta without pushing on the aneurysm.

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Procedure Types

Fenestrated endovascular aortic repair (FEVAR)

Fenestrated endovascular aortic repair (FEVAR) is a relatively new minimally-invasive option for people with abdominal aortic aneurysms who don’t qualify for traditional endovascular aneurysm repair (EVAR). 

Traditional EVAR works when aneurysms are located far enough from the renal (kidney) arteries, which branch off the aorta, that the stent can be securely attached to the aorta. But for approximately 10 percent of patients with an abdominal aortic aneurysm, the aneurysm is too close to the arteries that branch off to the kidneys for traditional EVAR to work. The location of this aneurysm is complicated to treat and often requires open surgery to repair the weakened wall. Until recently, the only option these patients had was major abdominal surgery or no surgery at all.

FEVAR grafts can cover branch arteries of the aorta (such as the renal arteries) because the graft has holes that correspond to the position of the branching arteries within the aorta to allow for blood to flow through the graft into the branch vessel. The graft is inserted into the femoral artery via an incision in the groin. It is then guided through the blood vessel to the aneurysm. The holes are then positioned over the openings of the branch vessels such as the renal arteries so that the blood flow continues to these vital vessels while the graft is secured in place. Once the graft is implanted inside the aneurysm, blood can now flow through the diseased area without putting pressure on the aneurysm - allowing blood to flow to other branch vessel organs such as the kidneys. 

This procedure offers a number of benefits over open surgery, including shorter hospital stays, fewer complications and risks, and faster recovery times.

 

Source: https://www.umcvc.org/conditions-treatments/fenestrated-endograft-fevar

Chimney endovascular aortic repair (ChEVAR)

Chimney endovascular aneurysm repair (ChEVAR) is an alternative to Fenestrated endovascular aortic repair (FEVAR). This procedure helps blood flow more easily like smoke up a chimney. ChEVAR involves the placement of covered balloon-expandable stents into the renovisceral vessels up to the desired seal zone. An oversized standard infrarenal stent-graft is then deployed and balloon molded around these stents to create a seal.

Source: https://journals.sagepub.com/doi/full/10.1177/1526602817728069

Branched endovascular iliac aneurysm repair (IBE)

Branched endovascular iliac aneurysm repair (IBE) is a procedure that can repair aneurysms with aortic side branches. Self-expandable stent-grafts are used to connect the main aortic component into each of the side branches.

 

Source: https://www.mayoclinic.org/medical-professionals/cardiovascular-diseases/news/endovascular-repair-of-complex-aortic-aneurysms/mac-20429867

Thoracic Endovascular Aortic Repair (TEVAR)

Thoracic endovascular aortic repair (TEVAR) is a minimally invasive procedure to repair the major blood vessel in the body, called the aorta.The aorta exits the heart and carries blood to all the organs and the rest of the body. After leaving the heart, the aorta branches to the arms and the brain before running down the back of the chest (thorax) into the belly (abdomen). The aorta forks at the level of the belly button (umbilicus) into branches that go down each leg. Learn more.

 

Source: https://vascular.org/patient-resources/vascular-treatments/repair-thoracic-aortic-aneurysm/thoracic-endovascular-aortic


Next Steps for Patients

While some patients are candidates for self-referral to our cardiovascular specialists, we recommend that you ask your primary care physician for help with the process. Find a Provider

Provider Referrals

If you are a provider who would like to refer a patient for MaineHealth vascular services, please review our referral guidelines and call 207-662-8900Clinical Guidlines

MaineHealth Cardiovascular Programs:

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