Endovascular Aortic Repair (EVAR)
Endovascular Aortic Repair (EVAR) is a minimally invasive procedure used to treat abdominal aortic aneurysms (AAA) — a condition where a weakened section of the abdominal aorta bulges outward. If left untreated, an AAA can rupture, leading to life-threatening internal bleeding.
EVAR involves inserting a stent graft — a fabric-covered metal mesh tube — into the affected section of the aorta. This graft relines the weakened vessel, redirecting blood flow and reducing pressure on the aneurysm, helping prevent rupture.
When Is EVAR Performed?
EVAR is typically recommended when:
- An AAA measures 5.5 cm or larger in diameter.
- The aneurysm is growing quickly (more than 0.5 cm in 6 months).
- The aneurysm is causing symptoms like abdominal or back pain.
- Imaging shows a high risk of rupture.
The primary goal of EVAR is to prevent rupture by reinforcing the aortic wall with a stent graft that carries blood through a stable channel.
Understanding EVAR
Who Is a Candidate for EVAR?
You may be eligible for EVAR if:
- The size and location of your aneurysm fit certain anatomical criteria.
- Your femoral or iliac arteries can accommodate the procedure’s catheters.
- You are not a good candidate for open surgery due to age or other health conditions.
- There is healthy blood vessel tissue near the aneurysm to anchor the graft.
For aneurysms located near critical branching arteries or with more complex anatomy, other procedures such as Fenestrated EVAR (FEVAR) may be more appropriate.
How to Prepare for EVAR
Preparation involves:
- Managing blood pressure and cholesterol as advised.
- Quitting smoking and controlling other cardiovascular risk factors.
- Undergoing imaging tests (usually a CT angiogram) to plan the procedure.
- Adjusting medications under your provider’s guidance.
- Fasting for several hours before the procedure, as instructed.
What Happens During EVAR?
Step-by-Step Procedure
- Anesthesia: You’ll receive either general anesthesia or sedation to ensure comfort.
- Accessing the Arteries: Your healthcare provider will make small punctures in your groin to access the femoral arteries using specialized needles.
- Guide Wire and Catheter: A thin guide wire is inserted, followed by a catheter containing the stent graft. Real-time X-ray imaging (fluoroscopy) helps guide the catheter to the aneurysm.
- Deploying the Stent Graft: Once in place, the stent graft is expanded, creating a new, stable path for blood flow. It seals tightly to the aorta, isolating the aneurysm.
- Completion: The catheter and guide wire are removed. Since the puncture sites are small, stitches are usually not needed—only bandages are applied.
The procedure generally lasts 2 to 3 hours.
Post-Procedure Care
- Hospital Stay: Typically 1 to 3 days.
- Activity: Light activity is encouraged; avoid lifting more than 10 pounds for 1–2 weeks.
- Wound Care: Keep puncture sites clean and dry until healed.
- Medications: Continue prescribed medications, especially for blood pressure control.
- Follow-Up Imaging: Scheduled at 1 month, 6 months, 12 months, and annually to ensure the graft remains secure and detect complications like endoleaks.
Potential Risks
Like any procedure, EVAR carries some risks, including:
- Endoleak (continued blood flow into the aneurysm sac)
- Stent graft migration
- Infection
- Bleeding
- Kidney damage from contrast dye used during imaging
- Leg ischemia (reduced blood flow to the legs)
Your provider will discuss these risks and how they are managed.
Why choose EVAR
- Minimally invasive with no large incisions
- Faster recovery compared to open surgery
- Lower risk of infection and blood loss
- High success rate in preventing aneurysm rupture
Why choose RIVEA for EVAR
At RIVEA Vascular Institute, Endovascular Aortic Repair (EVAR) is performed with a focus on safety, precision, and patient-centered care.
Led by Dr. Karthik Mikkineni, Co-founder and Chief Vascular Specialist, RIVEA offers:
- U.S.-Trained Expertise: Dr. Mikkineni brings advanced international training in complex endovascular procedures, including EVAR and Fenestrated EVAR.
- Specialized Aortic Care: RIVEA is equipped with next-generation imaging and interventional technology for diagnosing and treating abdominal aortic aneurysms with accuracy.
- Minimally Invasive Techniques: Our team prioritizes endovascular solutions to reduce recovery time, hospital stays, and overall patient risk.
- Comprehensive Follow-Up: We ensure lifelong surveillance through structured follow-up protocols to monitor your stent graft and overall vascular health.
- Collaborative Care Approach: At RIVEA, every treatment plan is personalized through consultation with a multi-specialty team.
FAQs
Is EVAR a permanent solution?
The stent graft is designed to stay in place long-term. However, regular imaging follow-up is required to monitor its position and function.
How soon can I resume normal activities?
Most patients return to normal activities within 1–2 weeks, but heavy lifting should be avoided initially.
Will I feel the stent graft inside me?
No. The stent graft is internal and does not cause any sensation.
Is EVAR painful?
You may feel mild discomfort at the groin puncture sites, but most patients do not experience significant pain.
Our Team
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Dr. Karthik Mikkineni
MD, FACS, FSVS, RPVI
Dr. Karthik Mikkineni is an internationally recognized vascular and endovascular surgeon, known for his pioneering work in complex aortic interventions, limb salvage, and carotid disease management.
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