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Endovascular repair of abdominal aortic aneurysm (EVAR): who needs it, how it is done and what to expect afterward
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Endovascular aneurysm repair (EVAR), sometimes called aortic stenting, is a treatment for an abdominal aortic aneurysm performed from inside the blood vessel. Through punctures of the femoral arteries, a stent-graft — a fabric tube on a metal frame that excludes the aneurysm from the circulation — is passed into the aorta and expanded. There is no need to open the abdomen. This page explains who needs the procedure, how to prepare for it, how it is performed and why follow-up scans afterward are essential.
Who needs endovascular aneurysm 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 (2024 guidelines of the European Society for Vascular Surgery, ESVS). Smaller aneurysms are followed with ultrasound. An aneurysm that causes pain needs urgent rather than elective treatment.
Suitability for endovascular repair is assessed with CT angiography (computed tomography with contrast). The stent-graft needs a segment of healthy aorta below the renal (kidney) arteries where it can be securely anchored (the aneurysm neck), and the iliac and femoral arteries must be wide enough for the delivery system to pass through. When the anatomy is unsuitable, open aortic replacement is performed at the Center (by the vascular surgery department).
Endovascular repair or open surgery
Open surgery means an incision in the abdomen and replacement of the diseased segment of the aorta with a synthetic graft; recovery after it takes longer. Endovascular repair is less invasive: in the first weeks afterward the risk of complications and death is lower and recovery is faster. Over the years this advantage disappears: after EVAR a small risk of late aneurysm rupture remains, so follow-up is needed for life, and some patients need repeat procedures over time — usually also through a puncture.
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.
Tests and preparation
- CT angiography of the aorta: it is used to measure the aorta and select a stent-graft that fits the patient's anatomy
- Blood tests, including kidney function (creatinine), and an ECG; tests of the heart and lungs if needed
- Tell the doctor about an allergy to iodinated contrast or chronic kidney disease
- Do not stop any medicines on your own: the doctor will tell you what to pause and when
- Stop smoking — both before the procedure and after it
- Bring a disc with your CT angiography, discharge summaries and a list of the medicines you take
How endovascular aneurysm repair is performed
The procedure is performed in an angiography suite under spinal or general anesthesia. Through punctures of the femoral arteries in the groin, under X-ray guidance, a compressed stent-graft is passed into the aorta and expanded below the renal arteries; its limbs (the “legs”) extend into the iliac arteries. A check angiogram at the end of the procedure shows whether the aneurysm has been securely excluded from the circulation. The procedure usually takes 1.5–3 hours.
A similar procedure on the thoracic aorta is called TEVAR — thoracic endovascular aortic repair.
After the procedure: the first days
The hospital stay after endovascular repair is usually 2–4 days. The doctor will tell you when you can get up and walk. There may be bruising at the puncture sites in the groin. In the first days the body temperature sometimes rises slightly — this is the body's reaction to the stent-graft; the doctor assesses it when examining you.
For as long as the doctor advises at discharge, avoid heavy lifting and strenuous exertion. Ordinary walking is beneficial.
Follow-up after endovascular repair: why it is essential
After endovascular repair, a follow-up CT or ultrasound scan is done after 1 month and then every year. Follow-up is needed so that changes which cause no symptoms for a long time are detected early: an endoleak (blood flow into the aneurysm sac outside the stent-graft), displacement of the stent-graft or further growth of the aneurysm. Some endoleaks are only monitored; others are treated, most often also endovascularly, through a puncture.
Do not miss your follow-up scans, even if you feel well. Blood pressure control and stopping smoking are also important.
Possible complications
- A bruise, hematoma or bleeding at the puncture site in the groin
- An allergic reaction to contrast or worsening kidney function after contrast
- Heart, lung, kidney or bowel complications — rare; the risk is assessed before the procedure
- Endoleak — blood flow into the aneurysm outside the stent-graft; it is detected on follow-up scans
- Displacement of the stent-graft or blockage of one of its limbs — rare; with a blockage, a leg may suddenly become painful and cold
- The need for a repeat procedure over time — usually also endovascular
When it is urgent
Sudden severe abdominal, back or chest pain, or collapse: call an ambulance (103 in Ukraine) without delay. In a patient with an aortic aneurysm, including after endovascular repair, this may be a sign of aneurysm rupture; tell the dispatcher about the diagnosis and the procedure you have had.
Sudden pain, coldness, pallor or numbness in a leg: call an ambulance (103 in Ukraine). If these signs appear or sharply worsen over minutes or hours, especially with weakness of the foot or inability to move the toes, this may be acute limb ischemia — a sudden occlusion (blockage) of an artery. Irreversible tissue damage can develop within hours (roughly six), so do not wait until morning, do not warm the leg with a heating pad or hot water, and do not rub it.
Bleeding from the puncture site or a swelling that grows quickly: press on the puncture site and call an ambulance (103 in Ukraine). Lie down and keep pressing firmly on the puncture site with your palm until the ambulance arrives.
Redness, swelling, pus or increasing pain at the puncture site, a pulsating lump in the groin, or a fever after discharge need a doctor's examination: seek medical care the same day.
Frequently asked questions
Does endovascular aneurysm repair need general anesthesia?
Not always: it is performed under spinal or general anesthesia and usually takes 1.5–3 hours.
How long is the hospital stay after endovascular aneurysm repair (EVAR)?
Usually 2–4 days. The exact length of stay depends on your general condition and how the procedure went.
Is follow-up needed after endovascular aneurysm repair (EVAR)?
Yes, it is essential: CT or ultrasound after 1 month, then yearly, to detect complications in time, including an endoleak (blood flow into the aneurysm outside the stent-graft). Do not miss these scans, even if you feel well.
Stent-graft or open repair: which is better?
The choice depends on aortic anatomy, age and comorbidities. Endovascular repair is less invasive and allows a faster recovery, but it requires regular follow-up; open surgery is a more extensive operation, after which follow-up scans are needed less often. Both methods are available at the Center, so the decision is made in the patient's interest.
Can I have an MRI after endovascular aneurysm repair?
In most cases yes: modern stent-grafts usually allow an MRI under specific conditions. Before the scan, tell the staff about the stent-graft and show your discharge summary with its name; the final decision is made by the radiologist.
Can the aneurysm rupture after endovascular repair?
The risk is much lower than without treatment, but it is not zero — which is exactly why follow-up scans are needed. If you have sudden severe abdominal, back or chest pain, or collapse, call an ambulance (103 in Ukraine) without delay.
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.