EVAR and FEVAR

The aorta is the body’s largest artery, carrying oxygen-rich blood from the heart to smaller, branching arteries throughout the body. The aorta’s lower section, the abdominal aorta, runs from below the chest to the pelvis and carries blood to the lower body.

When a section of an artery’s wall weakens, it can form a bulge, or aneurysm. If the weakened area continues to grow, it can burst, causing severe internal bleeding. In rare cases, an aortic aneurysm can also lead to a dissection, a tear in the aorta’s wall.

Ruptured aneurysms and aortic dissections are potentially life-threatening emergencies that require immediate medical care. Learn more about aortic aneurysms and aortic dissections.

Treatment for an abdominal aortic aneurysm (AAA) focuses on preventing a rupture or dissection. Medication may be all you need to manage a small, stable aneurysm. With a small aneurysm, the risk of rupture may be so low that your surgeon may choose to monitor the aneurysm’s growth before recommending surgery.

Large (about 2 inches) or fast-growing aneurysms require either an endovascular procedure or open surgery to prevent the weakened area from rupturing or leaking. An endovascular approach means the work is done from within the aorta. We implant a device that channels blood flow but prevents pressure on the weakened area.

But not all aortic aneurysms can be repaired with an endovascular procedure. Our surgeons work closely with you to decide which procedure will provide you with the safest, most effective, longest-lasting results.

What is endovascular aneurysm repair (EVAR)?

Endovascular aneurysm repair (EVAR) is a minimally invasive alternative to open aortic aneurysm surgery. Your doctor inserts a catheter (thin, flexible tube) through a needle puncture or small incision, then guides it to the aortic aneurysm.

The doctor uses the catheter to place a stent graft (fabric-covered, metal-mesh tube) inside the aneurysm. Blood flows through the stent graft, reinforcing the aorta and relieving pressure on the aneurysm’s wall to prevent the aneurysm from rupturing.

What is fenestrated endovascular aneurysm repair (FEVAR)?

At a certain spot in the abdominal aorta, the renal arteries branch off and supply blood to the kidneys. Below that spot, we can use standard EVAR to repair aneurysms. At that spot or above it, we perform a related but more complex procedure using a different type of stent graft.

That graft, called a fenestrated stent graft, has openings (fenestrations) that align with the branches of the kidney arteries. Each fenestrated stent graft takes four to six weeks to make and relies on CT scans for a custom fit. The tailored openings are based on individual anatomy, matching the arteries’ size, exact location and angle at which they branch off.

If you urgently need FEVAR, our vascular specialists can expertly modify a ready-made stent graft to fit your anatomy.

What is thoracic endovascular aneurysm repair (TEVAR)?

TEVAR is an endovascular surgery to treat aneurysms in the upper (thoracic) aorta located in the chest. Research shows that TEVAR is more effective than open repair. It can also treat other thoracic aortic conditions such as thoracic aortic dissection and thoracic aortic ulceration. Learn more about TEVAR.

Minimally invasive procedures like EVAR and FEVAR offer several benefits compared with open aortic aneurysm repair. These benefits include:

• Option for people who can’t have open surgery for a variety of reasons, such as heart problems or chronic obstructive pulmonary disease (COPD)
• Smaller incisions or none at all, if a needle puncture is used
• Less bleeding during the procedure
• Shorter hospital stay (two to three days)
• Faster recovery (two weeks)

For both EVAR and FEVAR, your surgeon performs a catheter-based procedure to access the aortic aneurysm. The difference between the procedures is the type of device used:

• Standard, tube-shaped stent graft for EVAR
• Fenestrated (with tiny openings for kidney arteries) stent graft for FEVAR

The procedure to place the stent graft is the same for both types and includes several steps:

1. The surgeon makes either a needle puncture or a small incision in an artery, typically in your groin.
2. The doctor inserts a catheter into the incision or puncture and directs it through the artery to the aortic aneurysm.
3. The doctor guides a stent graft, a metal-mesh tube (stent) covered with thin fabric (graft), along the catheter to the aneurysm.
4. The stent graft is opened inside the aneurysm and attached to the aorta above and below the aneurysm.
5. The doctor checks the area for blood leaks into the aneurysm before removing the catheter and instruments.

After EVAR or FEVAR, you typically spend one night in the intensive care unit (ICU). Usually, you can expect to stay in the hospital for one or two additional nights. Your care team monitors your vital signs, and you receive pain medication as needed.

Before you leave the hospital, we provide instructions for at-home care. After you return home, your overall recovery time is about two weeks.

Your first follow-up appointment typically takes place about four to six weeks after the procedure. We perform a CT scan to make sure the stent graft is in place and blood is not leaking into the aneurysm. You’ll need to come back for ongoing care and monitoring with CT scans, typically at six months and 12 months, then yearly after that.