What are alternatives to an endovascular aneurysm repair (EVAR)?

Mark J. Russo, MD
Thoracic Surgery (Cardiothoracic Vascular)

Alternative to EVAR include: 

  • Medical management, which consists of (a) routine imaging procedures to monitor the size and rate of growth of the aneurysm; (b) controlling or modifying risk factors: steps such as quitting smoking, controlling blood sugar if diabetic, losing weight if overweight or obese, and controlling dietary fat intake may help to control the progression of the aneurysm; (c) medication: to control factors such as hyperlipidemia (elevated levels of fats in the blood) and/or high blood pressure
  • Open Aneurysm Repair. An incision is made in the abdomen to repair the aneurysm. A cylinder-like tube called a graft may be used to repair the aneurysm. Grafts are made of various materials such as Dacron (textile polyester synthetic graft) or polytetrafluoroethylene (PTFE, non-textile synthetic graft). This graft is sewn to the aorta, connecting one end of the aorta at the site of the aneurysm to the other end. The open repair is considered the surgical standard for an abdominal aortic aneurysm repair.
  • Hand-Assisted Laparoscopic Repair. Laparoscopic aneurysm repair gives the surgeon the ability to easily see and operate on the aneurysm (like open repair) but smaller incisions (like endovascular repair). Surgeons use special thin instruments called laparoscopes to insert a tiny camera into the abdomen to see the aneurysm and to perform some steps of the surgery, while other steps require the surgeon to insert a hand to access critical areas and to ensure that the new artificial graft is properly in place. Incisions are smaller (10-12 cm), compared to traditional open surgery. 
Alternatives to an endovascular aneurysm repair (EVAR, also called "stent grafting") include:
  • Watching and waiting. This requires regular tests to make sure your aneurysm isn't too large or growing quickly
  • Traditional (open) surgery to replace the weakened section of the aorta

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.