Aortic aneurysm repair - endovascular

Description

You will lie on a padded table in an operating room, in the radiology department of the hospital, or in a catheterization lab. You may receive general anesthesia (you are asleep and pain-free) or epidural or spinal anesthesia.

• Your doctor will make a small surgical cut near the groin, to find the femoral artery. Then your doctor will insert a stent (a metal coil) and a manmade (synthetic) graft through the cut into the artery.
• The doctor uses x-rays to guide the stent graft up into your aorta, to where the aneurysm is located. The doctor will open the stent using a spring-like mechanism and attach it to the walls of the aorta. Your aneurysm will eventually shrink around it.
• The doctor will then use x-rays again to make sure the stent is in the right place and your aneurysm is not bleeding inside your body.

Why the Procedure is Performed

Endovascular aortic repair is done because your aneurysm is very large, growing quickly, or is leaking or bleeding.

You may have an abdominal aortic aneurysm that is not causing any symptoms or problems. Your doctor may have found out about this problem when you had an ultrasound or CT scan for another reason. There is a risk that this aneurysm may open up (rupture) if you do not have surgery to repair it. However, surgery to repair the aneurysm may also be risky. In such cases, endovascular repair is an option.

You and your doctor must decide whether the risk of having this surgery is smaller than the risk of rupture if you do not have surgery to repair the problem. The doctor is more likely to recommend that you have surgery if the aneurysm is:

• Larger (about 2 inches or 5 cm)
• Growing more quickly (a little less than 1/4 inch over the last 6 to 12 months)

Endovascular repair has a lower risk of complications compared to open surgery. Your doctor is more likely to suggest this type of repair if you have other, more serious medical problems or are elderly.

Risks

Risks for any surgery are:

• Blood clots in the legs that may travel to the lungs
• Breathing problems
• Infection, including in the lungs, urinary tract, and belly
• Heart attack or stroke
• Reactions to medicines

Risks for this surgery are:

• Bleeding around the graft that needs more surgery
• Bleeding before or after procedure
• Blockage of the stent
• Damage to a nerve, causing weakness, pain, or numbness in the leg
• Kidney failure
• Poor blood supply to your legs, your kidneys, or other organs
• Problems getting or keeping an erection
• Surgery is not successful and you need open surgery
• The stent slips

Before the Procedure

Your doctor will carefully examine you and order tests before you have surgery.

Always tell your doctor or nurse what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.

If you are a smoker, you should stop. Your doctor or nurse can help. Here are other things you will need to do before your surgery:

• About two weeks before your surgery, you will visit your doctor to make sure any medical problems, such as diabetes, high blood pressure, and heart or lung problems, are well treated.
• You also may be asked to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), clopidogrel (Plavix), warfarin (Coumadin), and naprosyn (Aleve, Naproxen).
• Ask your doctor which drugs you should still take on the day of your surgery.
• Always tell your doctor or nurse if you get a cold, flu, fever, herpes breakout, or other illness before your surgery.

The evening before your surgery:

• Do NOT drink anything after midnight, including water.

On the day of your surgery:

• Take any medicines your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

Most people stay in the hospital for 3 to 5 days after this surgery, depending on the type of procedure they had. Compared to open surgery, you should recover more quickly, have less pain, and go home sooner.

During a hospital stay, you may:

• Be in the intensive care unit (ICU), where you will be watched very closely at first
• Have a urinary catheter
• Be given medicines to thin your blood
• Be encouraged to sit on the side of your bed and then walk
• Wear special stockings to prevent blood clots in your legs
• Receive pain medicine into your veins or into the space that surrounds your spinal cord (epidural)

Outlook (Prognosis)

Recovery after endovascular repair is usually fairly quick.

You will need to be watched carefully over time for signs or symptoms that your repaired aortic aneurysm is leaking blood.

Alternative Names

EVAR; Endovascular aneurysm repair - aorta; AAA repair - endovascular; Repair - aortic aneurysm - endovascular

References

Tracci MC, Cherry JR KJ.  The Aorta. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2012:chap 62.

De Bruin JL, Baas AF, Buth J, Prinssen M, Verhoeven EL, Cuypers PW, et al: DREAM Study Group. Long-term outcome of open or endovascular repair of abdominal aortic aneurysm. N Engl J Med. 2010;362:1881-1889.

United Kingdom EVAR Trial Investigators, Greenhalgh RM, Brown LC, Powell JT, Thompson SG, Epstein D, Sculpher MJ. Endovascular versus open repair of abdominal aortic aneurysm. N Engl J Med. 2010;362:1863-1871.

Update Date: 12/10/2012

Updated by: Shabir Bhimji, MD, PhD, Specializing in General Surgery, Cardiothoracic and Vascular Surgery, Midland, TX. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.