Endovascular repair for aortic aneurysm (EVAR) Q&As
Published by Bupa's health information team, March 2009.
Answers to questions about endovascular repair for aortic aneurysm
This section contains answers to common questions about this topic. Questions have been suggested by health professionals, website feedback and requests via email.
- Is surgery the only option if I have an aneurysm?
- Can I opt to have endovascular repair instead of open surgery?
- What follow-up will I need?
- How long will my stent graft last?
Is surgery the only option if I have an aneurysm?
Surgery is usually only recommended if your aneurysm is at risk of bursting. If the risk of this happening is low, your doctor will carefully monitor your condition and may suggest you make some lifestyle changes.
Explanation
Because the operation itself carries some risks, surgery is usually only recommended if your aneurysm is at risk of bursting. If your aneurysm is small (less than 5.5cm), then it's very unlikely to burst.
Your doctor will probably suggest you have regular ultrasound checks to see if the aneurysm grows over time. Doctors call this 'watchful waiting' or surveillance.
Your doctor may also suggest some other measures to try and stop your aneurysm from getting bigger or from bursting. These might include stopping smoking and taking medicines to control your blood pressure and cholesterol. This prevents the build-up of fatty deposits in your arteries - the main cause of aneurysms.
Sources
- Kumar P, Clark M. Clinical Medicine. 6th ed. London: Elsevier, 2005:868-869
- Kasper DL, Fauci AS, Longo DL, et al. Harrison's Principles of Internal Medicine. 16th ed. New York: McGraw-Hill, 2005:1481-1485
- Aortic aneurysm and dissection - questions. British Heart Foundation. www.bhf.org.uk, accessed 19 March 2008
Can I opt to have endovascular repair instead of open surgery?
Your doctor will need to advise you on whether open surgery or having endovascular repair will be better for you. Endovascular repair is not suitable for everybody.
Explanation
For some people, having endovascular repair is not possible, due to the location or shape of their aneurysm or size of the arteries in the groin. Even for those people who are suitable for the procedure, open surgery is still often considered to be the better option - especially for those who are young and otherwise fit.
This is because there is a need for life-long follow-up after endovascular repair and a risk of needing further treatment, which outweighs the small benefit of having this type of procedure for many people.
Sources
- Greenhalgh RM, Powell JT. Endovascular repair of abdominal aortic aneurysm. N Engl J Med 2008; 358:494-501
- The EVAR Trial Participants. Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR Trial 1): randomised controlled trial. Lancet 2005; 365(9478):2179-2186
What follow-up will I need?
You will need regular check-ups for the rest of your life following endovascular repair.
Explanation
It is quite common for complications to happen after this type of procedure. For example, the stent may move position or it may break. Because of this, you will need lifelong follow-up to check that your stent is still in place and is working properly.
You will usually need to have a follow-up CT angiogram about a month after you first have your procedure, and again after about six months. A CT angiogram creates a three-dimensional picture of the body, and uses a dye to show up the aorta. You will continue to need check ups every year after this.
If a problem is identified during one of your check-up appointments, you will be advised if you need to have further surgery.
Sources
- The EVAR Trial Participants. Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR Trial 1): randomised controlled trial. Lancet 2005; 365(9478):2179-2186
- Stent-graft placement in abdominal aortic aneurysm. National Institute for Health and Clinical Excellence (NICE), March 2006. www.nice.org.uk
- Greenhalgh RM and Powell JT, Endovascular repair of abdominal aortic aneurysm. N Engl J Med 2008; 358:494-501
How long will my stent graft last?
As endovascular repair is a relatively new procedure, doctors don't have much information on the durability of stent grafts over the long-term.
Explanation
There is a chance that you may need further surgery to replace your stent graft if you have had complications after the initial procedure, such as blood leaking out of the stent graft (an endoleak). However, it is not known how likely this is to happen over the long term, as researchers currently only have data on how people have fared over a period of a few years. In addition, it will depend on the type of stent graft that your surgeon uses - as scientists are constantly trying to develop new devices to improve durability.
This is why your doctor will want to monitor your progress.
Sources
- Greenhalgh RM, Powell JT, Endovascular repair of abdominal aortic aneurysm. N Engl J Med 2008; 358:494-501
Related topics
This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
Publication date: March 2009
Endovascular repair for aortic aneurysm (EVAR) factsheet
Visit the endovascular repair for aortic aneurysm (EVAR) health factsheet for more information.
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