Endovascular Aneurysm Repair (EVAR)

An aortic aneurysm is a weakened, bulging segment of the aorta that grows over time and can rupture — an event that is frequently fatal. Endovascular aneurysm repair treats it from the inside. A fabric-covered stent graft is compressed into a delivery catheter, advanced through the femoral arteries in the groin, and deployed across the aneurysm. Blood then flows through the graft rather than against the weakened wall, and the pressure that drives expansion is relieved.

The abdominal version is EVAR; a repair in the chest is TEVAR. Compared with open repair, recovery is dramatically shorter — days instead of weeks.

Repair is advised when the risk of rupture outweighs the risk of the procedure. Common thresholds are an abdominal aneurysm around 5.5 cm in men or 5.0 cm in women, rapid growth of roughly half a centimeter or more in six months, or any aneurysm causing symptoms. Below those sizes, aneurysms are usually monitored with periodic imaging while blood pressure is controlled and smoking is stopped — surveillance is treatment, not inaction.

Not every aneurysm is suitable for EVAR. There must be an adequate landing zone of healthy aorta above and below, and the access arteries must accommodate the device. A cardiac CT angiogram determines this precisely, and where anatomy is unfavorable, fenestrated or branched grafts, or open surgical repair, may be recommended instead.

EVAR usually takes two to four hours, under general or regional anesthesia, sometimes with sedation alone. Access is through both groins, frequently percutaneously with no incision to close. Contrast dye and X-ray guide the graft into position, and completion imaging confirms the aneurysm is sealed.

Most patients stay one to two nights and are walking the day of or the day after the procedure.

Return to light activity typically comes within one to two weeks, avoiding heavy lifting for about a month. Groin bruising is common. Some patients experience post-implantation syndrome in the first days — low-grade fever, fatigue and elevated inflammatory markers without infection — which settles on its own but should still be reported so infection can be excluded.

EVAR requires imaging surveillance for life, typically a CT or ultrasound at intervals starting within the first year and continuing annually or as directed.

The reason is endoleak: blood finding its way back into the aneurysm sac around or through the graft, which can allow the aneurysm to keep growing and eventually rupture despite the repair. Endoleaks are usually treatable when found, and many require nothing more than closer monitoring — but they are silent, and imaging is the only way to detect them.

This is the central trade-off with open repair, which needs far less follow-up. Choosing EVAR means committing to those appointments, and patients who stop attending lose much of the protection the repair provides.

Sudden severe abdominal, flank or back pain, fainting, or a pulsating sensation with pain requires immediate emergency evaluation — call 911. Also report fever, groin bleeding or an expanding lump, or new leg pain or coldness.

Bleeding or injury to the access arteries, kidney injury from contrast, endoleak, graft movement or kinking, and rarely limb ischemia, bowel ischemia, or spinal cord injury with thoracic repairs. Your vascular surgeon will review the specific anatomy and risks in your case.