What happens during an endovascular aneurysm repair (EVAR)?

Endovascular aneurysm repair (EVAR) is a procedure performed to repair an abdominal aortic aneurysm -- a bulging, weakened area in the wall of the aorta. Generally, an EVAR follows this process:
  1. An intravenous (IV) line will be started in your arm or hand. Additional catheters will be inserted in your neck and wrist to monitor the status of your heart and blood pressure, as well as for obtaining blood samples. Alternate sites for the additional catheters include the subclavian (under the collarbone) area and the groin.
  2. You will be placed in a supine (on your back) position on the operating table or on a procedure table in a radiology suite.
  3. The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery. Once you are sedated, a breathing tube may be inserted through your throat into your lungs and you will be connected to a ventilator, which will breathe for you during the surgery.
  4. The physician may choose regional anesthesia instead of general anesthesia. Regional anesthesia is medication delivered through an epidural (in the back) to numb the area to be operated on. You will receive medication to help you relax and analgesic medication for pain relief. The physician will be able to talk to you during the procedure. The physician will determine which type of anesthesia is appropriate.
  5. The physician will make an incision in each groin to expose the femoral arteries. Using fluoroscopy (a type of x-ray "movie" that transmits images to a TV-like monitor), the physician will insert a needle into the femoral artery through which a guidewire will be passed and advanced to the aneurysm site. The needle will be removed and a sheath slid over the guidewire.
  6. An aortogram (injection of contrast dye to visualize the position of the aneurysm and adjacent blood vessels) will be performed.
  7. The physician will use special endovascular instruments and x-ray images for guidance. A stent-graft will be inserted through the femoral artery and advanced up into the aorta to the site of the aneurysm.
  8. The stent-graft, in a collapsed position until after it is inserted, will be advanced up into the aorta and situated at the aneurysm site. The stent graft will be expanded (in a spring-like fashion) and attached to the wall of the aorta.
  9. An aortogram will be repeated to check for an endoleak (blood leaking out into the aneurysm sac) of the stent-graft.
Mark J. Russo, MD
Thoracic Surgery (Cardiothoracic Vascular)

An endovascular stent graft repair is a treatment for aneurysms of the descending (thoracic and abdominal) aorta. It is similar to the approach used for a cardiac catheterization of the coronary arteries. This procedure requires only small incisions in the groin. Then the surgeon inserts a catheter through the femoral artery in the groin and with the use of x-ray guidance and specially-designed instruments, the aneurysm can be repaired from inside the aorta by inserting a tube, called a stent-graft. This is possible because the tube, or stent graft, is delivered through the catheter in a collapsed state and then expanded at the site of the aneurysm. 
Endovascular repair of a descending aortic aneurysm: The tube replaces and reinforces the diseased aortic wall, ensuring continuity of blood flow while preventing further expansion of the aorta, aortic rupture, and/or aortic dissection.  

The potential benefits of the procedure include greatly reduced risk, a shorter hospital stay, and a more rapid recovery. 

An endovascular aneurysm repair (EVAR, also called "stent grafting") procedure usually takes 2 to 3 hours. Here's what happens:
  • Preventing pain. In most cases, you will have general anesthesia -- medication so that you sleep through the procedure, feel nothing, and don't remember it afterward. If you don't have general anesthesia, you will have medication that numbs the area for the procedure.
  • Incisions. The doctor will make two small incisions (cuts) into blood vessels in your groin. The doctor will insert a sheath (a short plastic sleeve) into each incision. The sheath holds the artery open just enough to let guide wires or catheters (tiny tubes) through.
  • Finding the aneurysm. The doctor will put a guide wire through one of the sheaths into the artery. X-ray images on a video screen will show the guide wire as it moves up to the aneurysm.
  • Inserting the stent graft. The doctor will insert a catheter through each sheath and into the artery. One catheter will be fitted with a compressed stent graft. The doctor will thread the catheter up the artery to the aorta, using the guide wire to guide its path. The other catheter will help fit the graft into the aneurysm.
  • Removing the catheters. The doctor will take out the catheters, leaving the stent graft in place. The graft will expand to seal against the artery wall on either side of the aneurysm. Blood will flow through the graft, avoiding the aneurysm.
  • Closing the incisions. Each incision will be closed with a stitch or closure device.

Continue Learning about Aneurysms

Aneurysms: Deadly but Preventable
Aneurysms: Deadly but Preventable
We rely on our arteries to carry oxygen-rich blood to all the organs, muscles and tissues of the body. Every beat of the heart sends more blood throug...
Read More
How is an aneurysm diagnosed?
Dr. David W. Drucker, MDDr. David W. Drucker, MD
When you come to a doctor with a vascular problem like an aneurysm, he or she will evaluate your who...
More Answers
What are the complications during and after endovascular surgery?
Dr. Michael L. Schwartz, MDDr. Michael L. Schwartz, MD
There are very few complications during and after endovascular surgery. Endovascular surgery is a "m...
More Answers
How is endovascular surgery used to treat aneurysms?
Mark J. Russo, MDMark J. Russo, MD
Endovascular stent grafting is similar to the approach that is used for a cardiac catheterization of...
More Answers

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.