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Aortic aneurysm: when repair is needed and how EVAR is done
An aneurysm is a pathological enlargement of the aorta, the body's largest artery. It remains asymptomatic for years, but as the diameter grows so does the risk of rupture, which carries a high mortality. The modern treatment is endovascular aneurysm repair (aortic stenting): a stent-graft is implanted through femoral artery punctures, without opening the abdomen or chest.
Risk groups
- Men over 65, especially smokers
- Relatives of patients with an aortic aneurysm
- Hypertension, atherosclerosis elsewhere
At what size does an aneurysm need repair?
Elective repair of an abdominal aortic aneurysm is considered when its diameter reaches 5.5 cm in men or 5.0 cm in women, or when it grows rapidly (ESVS 2024 guidelines). Smaller aneurysms are followed with ultrasound; the doctor sets the interval according to the diameter. An aneurysm that causes pain needs urgent rather than elective treatment — see “When it is urgent”.
When it is urgent
Sudden severe abdominal, back or chest pain, or collapse, in a patient with an aneurysm: call an ambulance (103 in Ukraine) without delay. This may be a sign of rupture; tell the dispatcher that an aortic aneurysm has been diagnosed.
Diagnosis
Screening is an ultrasound of the abdominal aorta, recommended for people at high risk (see “Risk groups”); the doctor decides from the result whether a repeat scan is needed. For planning, CT angiography is used to select a stent-graft that fits the patient's aortic anatomy.
Endovascular repair
EVAR (abdominal) and TEVAR (thoracic aorta): through punctures of the femoral arteries a stent-graft is implanted in the aorta and excludes the aneurysm from the circulation. No incision, hospital stay of 2–4 days. Scheduled CT or ultrasound follow-up is required afterwards, because a stent-graft needs surveillance. When the anatomy is unsuitable, open aortic replacement is performed at the Center.
Frequently asked questions
My aneurysm is 4 cm. What is the strategy?
Surveillance: regular ultrasound (the doctor sets the interval by diameter), blood-pressure control and stopping smoking. Elective repair is considered at 5.5 cm in men or 5.0 cm in women, or with rapid growth.
How long does endovascular repair take?
Usually 1.5–3 hours under spinal or general anesthesia.
Is follow-up needed after EVAR?
Yes, it is essential: CT or ultrasound after 1 month, then yearly, to detect rare complications (endoleaks) in time.
Stent-graft or open surgery?
The choice depends on aortic anatomy, age and comorbidities. Both methods are available at the Center, so the decision is made in the patient's interest.
Book a consultation
Vascular surgeon consultation at the Shalimov Center, 30 Akademika Shalimova St, Kyiv. Booking and questions go through the contact doctor, Yurii Vahis. Patients from other cities and abroad can arrange an online consultation.
+380 44 454 20 79