Endovascular Aortic Repair
(-EVAR)
What Is Endovascular Treatment?
Endovascular treatment is a modern, less invasive way to repair problems in the aorta, the body’s main blood vessel. Instead of large surgical cuts, doctors use tiny entry points to reach the aorta from inside the blood vessels, using special tools and live imaging.
How Does It Work?
Doctors start by making a small opening, usually in the groin. Through this, thin flexible tubes (catheters) are guided up to the aorta using X-rays or other imaging. The main tool used is a stent graft, a small metal mesh tube covered with fabric. This device is designed to fit inside the aorta and support its walls. Once in place, the stent graft opens up and creates a new channel for blood to flow, sealing off weak or damaged areas like aneurysms or tears.
When Is Endovascular Treatment Used?
This procedure is mainly used to treat serious aortic problems like:
Aortic aneurysms: bulging weakened areas in the aorta wall (Referring to relevant chapter).
Aortic dissections: tears inside the wall of the aorta (reference to relevant chapter).
Penetrating ulcers: damaged spots that could lead to tearing or bleeding (Refererring to relevant chapter).
It is often chosen when doctors want to avoid open surgery, or when patients have conditions that make major surgery too risky. For some areas of the aorta, especially the descending thoracic aorta (Reference), it’s now a common first choice.
Benefits and Limitations
The main benefits are smaller cuts, less pain, shorter recovery, and a lower risk of infection compared to open surgery. However, not all aortic problems can be fixed this way. Sometimes, the shape or position of the aorta or its branches isn’t suitable for a stent graft. Also, over time, some patients may need another procedure if the stent graft shifts or leaks.
What to Expect During the Procedure
Endovascular procedures may be done while awake using local anesthetics, or it may be done while the patient is sleeping. The anesthesiologist responsible will explain which approach fits your case before surgery. A small cut is then made in your groin, and the team uses special X-rays to guide the stent graft up into your aorta. When the graft is in the right position, it’s carefully opened and anchored in place to protect the weak or damaged area. Procedure time, as well as recovery time are often shorter than with open surgery.
Possible Risks and Complications
Complications are rare but can include:
Bleeding at the entry site.
Blood clots or blockage of blood flow to organs.
Leaks around the stent graft (“endoleaks”).
Movement of the graft that may require further treatment.
Your care team will keep a close eye on you after the procedure, including with regular imaging scans, to catch and fix any problems early.
Endovascular Treatment in Aortic Disease
For many aortic conditions, endovascular repair now allows doctors to treat issues that once required major surgery. This approach helps protect the aorta quickly and gently, with fewer risks and a faster return to daily life for most patients. As new devices are developed, like special “branched” or “custom” stent grafts, even more people with complex aortic diseases can benefit from minimally invasive treatment.