Aortic aneurysm repair - endovascular

Definition

Endovascular abdominal aortic aneurysm repair is surgery to fix a widened part (or aneurysm) in your aorta, the large artery that carries blood to your belly, pelvis, and legs.

An aortic aneurysm is when a part of this artery becomes too large, or balloons outward, due to weakness in the wall of the artery.

Alternative Names

EVAR; Endovascular aneurysm repair; AAA repair - endovascular; Repair - aortic aneurysm - endovascular

Description

You will lie down on a padded table in an operating room, in the radiology department of the hospital, or in a catheterization lab. You may receive general anesthesia (asleep and pain-free) or epidural or spinal anesthesia.

• Your doctor will make a small incision (cut) near the groin, to find the femoral artery. Then your doctor will insert a stent (a metal coil) and a manmade (synthetic) graft through the cut into the artery.
• The doctor uses x-rays to guide the stent graft up into your aorta, to where the aneurysm is located. The doctor will open the stent using a spring-like mechanism and attach it to the walls of the aorta. Your aneurysm will eventually shrink around it.
• The doctor will then use x-rays again to make sure the stent is in the right place and your aneurysm is not bleeding inside your body.

Why the Procedure Is Performed

If you have bleeding inside your body from an aortic aneurysm, you will have open abdominal aortic aneurysm repair. Endovascular repair is rarely done for a leaking or bleeding aneurysm.

You may have an abdominal aortic aneurysm that is not causing any symptoms or problems. Your doctor may have found out about this problem from special tests called an ultrasound or CT scan. There is a risk that this aneurysm may open up (rupture) if you do not have surgery to repair it. However, surgery to repair the aneurysm may also be risky.

You and your doctor must decide whether the risk of having this surgery is smaller than the risk of bleeding if you do not have surgery to repair the problem. The doctor is more likely to recommend you have surgery if the aneurysm is:

• Larger (about 2 inches)
• Growing more quickly (a little less than 1/4 inch over the last 6 to 12 months)

Endovascular repair has a lower risk of complications around the time of the surgery. Your doctor is more likely to suggest this surgery if you have other more serious medical problems or if you are elderly.

Risks

Risks for any surgery are:

• Reactions to medicines
• Breathing problems
• Blood clots in the legs that may travel to the lungs
• Heart attack or stroke
• Infection, including in the lungs, urinary tract, and belly

Risks for this surgery are:

• Bleeding before or after procedure
• Poor blood supply to your legs, your kidneys, or other organs
• Damage to a nerve, causing pain or numbness in the leg
• Bleeding around the graft requiring more surgery

Before the Procedure

Your doctor will do a thorough physical exam and tests before you have surgery.

Always tell your doctor or nurse what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.

If you are a smoker, you should stop. Your doctor or nurse can help.

• During the 2 weeks before your surgery, you will visit your doctor to make sure medical problems, such as diabetes, high blood pressure, and heart or lung problems, are being treated well.
• You also may be asked to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), clopidogrel (Plavix), warfarin (Coumadin), naprosyn (Aleve, Naproxen), and other drugs like these.
• Ask your doctor which drugs you should still take on the day of your surgery.
• Always let your doctor know about any cold, flu, fever, herpes breakout, or other illness you may have before your surgery.

Do NOT drink anything after midnight, the day before your surgery, including water.

On the day of your surgery:

• Take the drugs your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

Most people stay in the hospital for 3 to 5 days after this surgery, depending on the type of procedure you had. During a hospital stay, you may:

• Be in the intensive care unit (ICU), where you will be watched very closely at first
• Have a urinary catheter
• Be given medicines to keep your blood thin
• Be encouraged to sit on the side of your bed and then walk
• Wear special stockings to prevent blood clots in your legs
• Receive pain medicine into your veins or into the space that surrounds your spinal cord (epidural)

Outlook (Prognosis)

Recovery after endovascular repair is usually fairly quick. You will need to be watched carefully over time for signs or symptoms that your repaired aortic aneurysm is leaking blood.

References

Gloviczki P, Ricotta JJ II. Aneurysmal vascular disease. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 65.

Greenhalgh RM, Powell JT. Endovascular repair of abdominal aortic aneurysm. N Engl J Med. 2008 Jan 31;358(5):494-501.

Lederle FA, Kane RL, MacDonald R, Wilt TJ. Systematic review: repair of unruptured abdominal aortic aneurysm. Ann Intern Med. 2007 May 15;146(10):735-41.