What is an Endovascular Aneurysm Repair?

Endovascular aneurysm repair (EVAR) is also known as endovascular stent graft. By either name, this procedure refers to a closed chest method of repairing certain aneurysms, most often aortic, but sometimes also thoracic ones. Aneurysms are great weaknesses in a blood vessel that can cause it to ultimately collapse or burst, which is immediately life threatening. While the standard method for repairing these is to open the chest, or other part of the body, and remove or strengthen the affected artery, interest in doing a less invasive procedure has led to the development of EVAR.

The basic method by which endovascular aneurysm repair is effected is with stenting and catheterization or angiography. Instead of cutting into the chest, a surgeon or cath specialist, often a vascular surgeon, uses mild sedation on a patient and accesses the source of the aneurysm via an artery in the groin. A catheter that contains a stent is threaded through the artery until it reaches the source of the aneurysm. The stent is then released to stabilize the aneurysm and prevent the vessel from being able to quickly deteriorate.

The other method for performing thoracic or aortic aneurysm repair is an open procedure. The chest is cut open and the aneurysm located and repaired. This surgery usually involves a much longer in-hospital recovery time and it is verifiably more painful while a person is in recovery. In short-term estimates, such as the first month after surgery, it has a slightly higher mortality rate than endovascular aneurysm repair, but over the long term, both procedures are thought to be about equal in survival rate.

There are big questions that have led to continuing studies on the benefits of endovascular aneurysm repair versus open procedures. Thus far, researchers have found that EVAR has benefits in early stages due to its short recovery time and slightly reduced early mortality rate, but that it requires greater follow-up than open repairs and tends to be more costly. These factors are good ones to consider with a vascular surgeon, provided there is time to consider them, which is not always the case.

It should be noted that not all people are good candidates for endovascular aneurysm repair, and others are more at risk if they have open surgeries. High risk for open surgery suggests EVAR is the better choice. Another thing that may influence this decision include aneurysm size, as smaller size may not be large enough for a stent. Aneurysm location can matter too. Whenever EVAR is considered, one principle question asked is whether the stent will adequately reinforce the artery; if this is not the case, open surgery is normally preferred.