Cardiovascular diseases vary from minor to life-threatening, most notably aortic aneurysm, which affects approximately 4.8% of adults over 65 years old. To treat this serious condition without the complications of surgery, endovascular aortic aneurysm repair is a unique medical development that avoids open surgery, as it relies on an advanced technique that provides effective results with a quick recovery, especially for the elderly and those with critical health conditions.
What is endovascular aortic aneurysm repair?
Endovascular aortic aneurysm repair (EVAR) is a minimally invasive medical procedure that involves inserting a catheter through the femoral artery to repair an aneurysm in the aorta. It is primarily used to treat abdominal or thoracic aortic aneurysms and is an effective alternative to traditional surgery, as endovascular aortic aneurysm repair can be completed without the need to open the chest or abdomen.
Who are the candidates for this procedure?
Endovascular aortic aneurysm repair can be an option for patients with an aortic aneurysm in the following cases:
- Patients with an aortic aneurysm greater than 5.5 centimeters.
- Patients who are not suitable for open surgery due to age or the presence of chronic diseases such as heart disease or diabetes.
- Patients who have had previous major abdominal or thoracic surgery.
- Patients with critical health conditions that make open surgery more risky.
Endovascular aortic aneurysm repair procedure steps
Pre-procedure
The doctor will first ask the patient about their medical history and perform a complete physical examination, then perform an electrocardiogram (ECG) to measure the electrical activity of the heart, then perform stress tests such as the Cardiopulmonary Exercise Test (CPEX) or other stress tests to determine the health of the heart and lungs, the doctor will also perform imaging tests such as CT Angio or MRI to determine the exact location of the dilation, in addition to stopping certain medications and monitoring blood pressure.
During the procedure
At the beginning of endovascular aortic aneurysm repair, the patient is given general or local anesthesia with sedation to ensure that he does not feel discomfort during the procedure, then the doctor inserts a needle near the inguinal region through the skin and soft tissues towards the femoral artery and then inserts a catheter carrying a coated stent (stent graft) Then the catheter is guided through the arteries using animated X-ray images until it reaches the site of the dilation, where the doctor then opens the stent to expand, forming a new path for the blood to ensure that the blood does not reach the aneurysm, preventing rupture, and is precisely fixed by its metal structure.
Convalescence and recovery
After completing the operation, the patient is transferred to the intensive care unit (ICU) for several hours, where vital signs are monitored (heart rate, pressure, respiration, oxygen level). The patient may need to lie flat for hours to prevent bleeding while receiving painkillers. After that, they are transferred to a regular room and typically stay in the hospital for one to three days depending on their condition. Within a week, the patient can begin to return to daily activities.
However, heavy lifting should be avoided for 4–6 weeks, and driving should be postponed until the pain in the groin area has subsided. Full recovery may take anywhere from a few days to several months. The patient must take the prescribed medications and commit to regular follow-up every 6–12 months, including imaging tests to monitor the success of the treatment.
What are the possible risks or complications?
Although endovascular aortic aneurysm repair is considered less risky than open surgery, it is not without potential risks and complications. These risks may include injury to blood vessels or neighboring organs during the procedure, bleeding and infection at the site of catheter insertion (usually in the groin area), and the formation of blood clots that may obstruct blood flow to the legs, feet, or intestines.
In addition to these risks, one of the most prominent complications associated with stent implantation is stent leakage, known as Endoleak. This occurs when blood leaks around the stent or from its tips into the original aneurysm sac. If left untreated, an endoleak can cause the artery to continue expanding, potentially leading to rupture.
A common complication of endovascular aortic aneurysm repair is the deterioration of kidney function (often temporary), mainly due to the effect of the radiation dye used during the procedure, as well as the possibility of deep vein thrombosis (DVT). Blockage of branch arteries originating from the aorta is also a potential but rare risk.
Comparison between catheterization and open surgery
| Year | Catheterization | Open surgery |
| Type of anesthesia | General or localized | General |
| Length of hospitalization | 1-3 days | 5-10 days |
| Recovery time | Approximately one week | 4-6 weeks |
| Severity level | Relatively less | Higher for people with chronic diseases |
| Potential for reopening | present in a small percentage | Rare if done accurately |
In conclusion, endovascular aortic aneurysm repair represents a paradigm shift in the treatment of aortic aneurysms, especially for the elderly and patients who cannot undergo open surgery. Endovascular aortic aneurysm repair provides a safe and effective option that minimizes the risks of surgery and speeds up the recovery period. While this procedure remains an ideal option for many patients, regular follow-up and continuous evaluation remain key factors to ensure successful treatment and long-term stability.
Sources:
- Torsello, G. F., & Guglielmo, R. (2013). Endovascular repair of aortic aneurysms: current status and future perspectives. Journal of Vascular Surgery, 57(6), 1534-1544.
- Society for Vascular Surgery. (n.d.). Endovascular repair of abdominal aortic aneurysms.
