EVAR and TEVAR: Closed Treatment of Aneurysms With a Stent

In the treatment of aortic aneurysms we no longer always need open surgery; in patients with suitable anatomy we can treat the aneurysm with a closed technique by placing a stent-graft through a catheter introduced from the groin. In this article I will explain the EVAR and TEVAR methods.

What Is Endovascular Aortic Repair (EVAR/TEVAR)?

The method we apply in aortic aneurysms of the abdominal region is called EVAR (Endovascular Aneurysm Repair), while the similar method we apply in aortic disease of the chest (thoracic) region is called TEVAR (Thoracic Endovascular Aortic Repair). In both methods, with the help of a catheter introduced through the artery in the groin, the folded stent-graft is advanced to the aneurysmal segment and opened there, so that blood flow passes outside the aneurysmal wall, through the inside of the stent’s own metal-fabric frame.

Advantages Over Open Surgery

Because the abdominal or chest cavity is not opened at all, blood loss, pain and recovery time after EVAR/TEVAR are markedly less than with open surgery; we can discharge most of our patients within a few days. This advantage is especially valuable in elderly patients or those with comorbidities in whom the risk of open surgery is high.

Follow-Up and Tomography After the Procedure

After EVAR/TEVAR we perform follow-up with computed tomography at regular intervals (usually at months 1, 6 and 12, and annually thereafter) to assess whether the stent-graft has stayed in place and whether there is any leak (endoleak) around it. Although this follow-up is somewhat more frequent than after open surgery, it is the most important part of guaranteeing the long-term safety of the procedure.

Frequently Asked Questions

Can EVAR/TEVAR be applied to every aneurysm? No; the location of the aneurysm and the anatomy of the surrounding vessels determine whether this method is suitable.

Does the stent-graft stay in place for life? Yes, it is not removed; however, it needs to be followed up with regular imaging.

Is it safer than open surgery? In the short term it is less invasive and provides faster recovery; the need for long-term follow-up, on the other hand, is greater. The decision is made according to the patient’s anatomy and general condition.

Conclusion

EVAR and TEVAR allow us to treat aortic aneurysms in a far less invasive way than open surgery in patients with suitable anatomy. The decision is personalised according to the location of the aneurysm and the patient’s general condition.

You can book an appointment for detailed imaging and examination to assess whether EVAR/TEVAR is suitable for your aortic aneurysm.

References

1. Isselbacher EM, Preventza O, Hamilton Black J 3rd, et al. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease. Circulation. 2022;146(24):e334-e482.