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Endovascular Repair of Abdominal Aortic Aneurysm

(Minimally Invasive Repair of Abdominal Aortic Aneurysm; EVAR)

Definition

The aorta is the largest artery in the body. The abdominal part of the aorta is located below the diaphragm. It carries blood to the abdomen, pelvis, and legs. Sometimes, the walls of the aorta weaken and bulge in one area. This is called an abdominal aortic aneurysm (AAA). When the aneurysm reaches a certain size, it may need to be repaired. Endovascular repair of an AAA (EVAR) is done from the inside of the artery. The doctor inserts a stent graft into the area to strengthen it.
Abdominal Aortic Aneurysm
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Reasons for Procedure

This procedure is often done to repair AAA when the aneurysm:
  • Causes physical symptoms (eg, abdominal pain)
  • Causes complications (eg, clots that travel into the legs)
  • Reaches a certain size and position that meets criteria for EVAR
  • Has burst—Surgery must be done right away.
EVAR is now the preferred method to treat AAA. EVAR can result in less pain, shorter hospital stay, fewer complications, and faster recovery time compared to open surgery. However, closer follow-up over many years is needed.

Possible Complications

Your doctor will review a list of possible complications, which may include:
  • Adverse reaction to anesthesia
  • Infection
  • Bruising or bleeding
  • Damage to blood vessels or organs (possibly requiring open surgery)
  • Leaking of blood at the graft
  • Heart attack
  • Blood clots
Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:
  • Smoking
  • Drinking
  • Chronic disease such as diabetes or obesity
Your risk of complications may also be increased if you have had:
  • A recent or active infection
  • Bleeding or clotting disorders

What to Expect

Prior to Procedure

Your doctor may:
  • Do a physical exam, blood tests, and imaging tests (eg, CT scan )
  • Ask about your medical history, including allergies, current medicines, bleeding disorders, and other concerns
  • Have you meet with an anesthesiologist
Before the procedure:
  • Do not eat or drink for eight hours prior to the procedure.
  • Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
    • Anti-inflammatory drugs (eg, aspirin )
    • Blood thinners, such as clopidogrel (Plavix) or warfarin (Coumadin)

Anesthesia

Your doctor may use:

Description of the Procedure

You will lie on your back. You will receive medicine to ease pain and relax you. Once you are asleep and sedated, a breathing tube will be inserted into your throat and lungs. Sometimes, regional anesthesia will be used. A breathing tube will not be needed in this case.
The doctor will make small incisions in both sides of the groin. Catheters (thin tubes) will be inserted into the blood vessels and threaded up toward the aneurysm. Contrast dye will be injected through the catheters. The doctor will then guide a stent graft to the site. The graft will be placed into the weakened area and extended into both pelvic arteries. To guide each step, the doctor will use live x-ray images. Your vital signs will be monitored. Once the graft is in place, the doctor will remove the catheters. The incisions will be closed. Sterile bandages will be applied.

Immediately After Procedure

You will be taken to the intensive care unit (ICU). If you have a breathing tube, it will be removed. Your vital signs will be closely monitored.

How Long Will It Take?

About 2-3 hours

How Much Will It Hurt?

Anesthesia will prevent pain during the procedure. Your doctor will give you medicine to manage the pain during the recovery process. There is little discomfort from the groin incisions.

Average Hospital Stay

The usual length of stay is 1-2 days. Your doctor may choose to keep you longer if needed.

Post-procedure Care

At the Hospital
At the hospital, you will:
  • Gradually move around and increase your activity level
  • Slowly return to eating solid foods, as tolerated
During your stay, the hospital staff will take steps to reduce your chance of infection such as:
  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered
There are also steps you can take to reduce your chances of infection such as:
  • Washing your hands often and reminding visitors and healthcare providers to do the same
  • Reminding your healthcare providers to wear gloves or masks
  • Not allowing others to touch your incisions
At Home
When you return home, do the following to help ensure a smooth recovery:
  • Keep the incision areas clean and dry. Follow your doctor’s instructions for changing your bandages.
  • Ask your doctor about when it is safe to shower, bathe, or soak in water.
  • Take pain medicine as directed.
  • Ask your doctor which activities are safe for you.
  • Your condition needs to be carefully monitored. Be sure to go to all of your appointments.

Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occurs:
  • Redness, swelling, increasing pain, excessive bleeding, or discharge at the incision site
  • Signs of infection, including fever and chills
  • New abdominal pain
  • Back pain
  • Any change of color or sensation in your legs or feet
  • Burning, pain, or problems when urinating
  • Nausea or vomiting
  • Abdominal cramps or diarrhea
  • Unusual fatigue or depression
  • Disorientation or confusion
  • Numbness or tingling in the legs
  • Cough
  • New, unexplained symptoms
Call for medical help or go to the emergency room right away if you have:
  • Shortness of breath
  • Chest pain
If you think you have an emergency, call for medical help right away.

RESOURCES

American Heart Association http://www.americanheart.org/

Society for Vascular Surgery http://www.vascularweb.org/

CANADIAN RESOURCES

Canadian Cardiovascular Society http://www.ccs.ca/

Canadian Society for Vascular Surgery http://canadianvascular.ca/

References

Abdominal aortic aneurysm. Society for Vascular Surgery website. Available at: http://www.vascularweb.org/patients/NorthPoint/Abdominal%5FAortic%5FAneurysm.html. Updated January 2010. Accessed January 22, 2010.

Abdominal aortic aneurysm (AAA). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated January 22, 2010. Accessed January 27, 2010.

Abdominal aortic aneurism repair. Lancaster General Health website. Available at: http://www.lancastergeneral.org/content/greystone%5F27195.htm. Accessed January 25, 2010.

Dillon M, Cardwell C, Blair PH, Ellis P, Kee F, Harkin DW. Endovascular treatment for ruptured abdominal aortic aneurysm. Cochrane Database of Systematic Reviews website. Available at: http://www.cochrane.org/reviews/en/ab005261.html. Published January 24, 2007. Accessed January 22, 2010.

Endovascular repair of thoracic aortic aneurysms. Cleveland Clinic website. Available at: http://my.clevelandclinic.org/heart/disorders/aorta%5Fmarfan/endovascularaorticaneurysm.aspx. Updated August 2009. Accessed January 22, 2010.

Fotis T, Mitsos A, Perdikides T, et al. Regional Anesthesia versus general anesthesia in endovascular aneurism repair: the surgical nursing interventions. British Journal of Anesthetic and Recovery Nursing. 2009;10(1):11-14.

Minimally invasive surgery repairs potentially fatal aortic aneurysms. UCLA Health Systems website. Available at: http://www.uclahealth.org/body.cfm?xyzpdqabc=0&id=502&action=detail&ref=86. Published September 2006. Accessed February 2, 2010.

Revision Information

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