Abdominal aortic stent-grafting (EVAR)

An abdominal aortic aneurysm is a dilation of the main vessel in the abdomen, and it can be treated without open surgery, using minimally invasive techniques. The solution is to place a tube (a stent-graft) inside the aneurysm, which takes the blood from the healthy vessel and sends it on towards the legs. Performing this procedure restores the circulation of the aorta correctly, avoiding classic surgery with the opening of the abdomen.

EVAR at a glance

• Full name: EVAR — EndoVascular Aneurysm Repair
• Condition treated: abdominal aortic aneurysm
• Type of procedure: endovascular, minimally invasive — without opening the abdomen
• Access: through the femoral arteries, at groin level
• Advantages: reduced operative trauma, shorter hospitalisation and recovery
• After the procedure: periodic imaging monitoring of the stent-graft

What is an abdominal aortic aneurysm?

An abdominal aortic aneurysm (AAA) is a dilation of the main vessel in the abdomen, appearing through the weakening of the arterial wall. The dilated area grows progressively, and the thinned wall becomes ever more vulnerable to blood pressure.

The major risk is the rupture of the aneurysm — a life-threatening emergency, accompanied by strong back or abdominal pain, low blood pressure and a rapid pulse. It is precisely to prevent this outcome that an intervention is performed, either through open surgery or through EVAR. Details about causes, risk factors and diagnosis are on the Arterial conditions and Aortic artery surgery pages.

Who is EVAR recommended for?

EVAR is recommended for patients with an abdominal aortic aneurysm that requires treatment and whose vascular anatomy allows the stent-graft to be placed — especially those with an increased surgical risk, for whom open surgery would be too aggressive. The imaging evaluation (CT angiography) establishes the shape of the aneurysm, its position relative to the renal arteries and the condition of the access arteries, all of which decide whether the technique is feasible.

How does the procedure work, step by step?

1. Access — the femoral arteries are approached through small incisions or punctures at groin level.
2. Navigation — the folded stent-graft is introduced through the arteries and guided under imaging up into the aorta, to the level of the aneurysm.
3. Deployment and fixation — the stent-graft is opened and fixed in the healthy portions of the vessel, above and below the dilation.
4. The result — the blood now flows through the inside of the stent-graft, straight towards the legs; the aneurysm sac remains excluded from the circulation and is no longer exposed to the pressure that could have ruptured it.

What advantages does EVAR have over open surgery?

• no opening of the abdomen — much less operative trauma
• shorter hospitalisation and faster recovery
• suitable also for patients with an increased surgical risk, in cases with favourable anatomy
• the circulation of the aorta is restored correctly, without classic surgery

What comes after the procedure?

After EVAR, periodic imaging check-ups (ultrasound or CT) are necessary, to verify the position of the stent-graft and the complete exclusion of the aneurysm from the circulation. This long-term follow-up is the essential part of endovascular treatment — the exact check-up intervals are established by the vascular surgeon. Control of the risk factors also continues: blood pressure, cholesterol, stopping smoking.

Frequently asked questions

Is EVAR suitable for every aneurysm?

No — the anatomy of the aneurysm (its shape, its position relative to the renal arteries, the condition of the access arteries) has to allow the stent-graft to be fixed safely. In unsuitable cases, open surgical repair remains the reference solution.

How long is the recovery after EVAR?

Significantly shorter than after open surgery: hospitalisation is usually brief, and normal activities are resumed according to the doctor’s recommendation, often within a few days.

Does the stent-graft stay in permanently?

Yes, the stent-graft stays permanently in the vessel and takes over the role of the diseased portion of the aorta. Periodic imaging check-ups verify its position and correct functioning over time.

Why are check-ups needed after EVAR?

To confirm that the aneurysm remains completely excluded from the circulation and that the stent-graft keeps its position. Detecting any change early allows it to be corrected through a minor procedure, again endovascularly.