How to repair a blood vessel without a large incision (Endovascular Aneurysm Repair - EVAR)

Have you ever heard that the most important blood vessel in our body can swell up like a balloon? This is a really scary situation. But don't worry, with the advancement of medical science, this can now be treated in a very simple way without making a big incision. Today we are going to talk about it. This method is called EVAR.

Simply put, what is EVAR?

The full meaning of EVAR is Endovascular Aneurysm Repair . This is a minimally invasive surgery. It is used to treat aneurysms, or as we call them in medical terms , aneurysms , in the aorta, the main blood vessel in our abdomen.

Imagine that the largest blood vessel in our body is the aorta. This is where blood is distributed from the heart to the entire body. Sometimes, when a spot in the wall of this blood vessel becomes weak, the pressure of the blood causes that weak spot to bulge out like a balloon. That's what we call an aneurysm.

In EVAR treatment, only two very small holes are made on either side of the vein, and special instruments are passed through them to repair the swollen blood vessel from the inside.

Why do we need this EVAR treatment?

The main goal of this treatment is to prevent the balloon-like blood vessel (aneurysm) from bursting, because if it does, it is a major threat to life.

In EVAR treatment, doctors insert a special tube (stent graft) made of fabric and metal mesh into the swollen blood vessel. After this tube is inserted, blood flows through this new tube. Then the pressure of the blood does not hit the weakened wall of the swollen blood vessel. Therefore, the risk of it bursting is almost completely eliminated.

Who is this EVAR treatment best suited for?

If you have an aortic aneurysm, this treatment may be right for you. However, not all aneurysms are treated at the same time. Your doctor may consider EVAR in the following cases:

• If your aneurysm is large or if it is small but is growing rapidly .
• If your body cannot tolerate open surgery with a large incision.
• If the blood vessels above and below the aneurysm are healthy .

Are there other methods like EVAR? (FEVAR and TEVAR)

Yes, this treatment method is used with slight variations depending on the location of the aneurysm.

What is FEVAR?

Think of our aorta as a tree trunk. From this trunk, branches (small arteries) that carry blood to organs in our abdomen (like kidneys and intestines) divide. Sometimes an aneurysm forms near the point where one of these branches divides. In that case, it is difficult to perform a regular EVAR.

It is for such complex cases that a special method called FEVAR (Fenestrated Endovascular Aneurysm Repair) is used. The stent graft used here has small holes (fenestrations) made to fit where the branches divide. Through those holes, separate small stents can be placed for those branches. Just like a tube designed to fit both the trunk and the branches of a tree.

Difference between EVAR and TEVAR

This is very simple.

• EVAR is performed for aneurysms in the abdomen (stomach) .
• TEVAR (Thoracic Endovascular Aneurysm Repair) is performed for aneurysms in the chest cavity (thorax) .

TEVAR is usually very successful for aneurysms in the great arteries that run down through the chest, a little further from the heart. However, for aneurysms that are very close to the heart, open surgery is often required.

Are there any risks with this treatment?

EVAR is a very safe and highly successful treatment, but like any surgery, there is a small chance of complications.

• Blood Clots: Sometimes blood clots can form in the deep veins of the legs. We call this Deep Vein Thrombosis (DVT) .
• Endoleak: Even after the stent is placed, a small amount of blood leaks between the stent and the wall of the blood vessel and joins the aneurysm.
• Infection: Infection at the site of injury.
• Kidney failure
• Heart attack
• Excessive bleeding

These risks are very low. Your doctor will explain all of this to you before the surgery.

How is the surgery done?

Okay, now let's look at the steps involved in this surgery.

1. First, you will be given anesthesia to either put you to sleep or to be in a light sleep. So you will not feel any pain.

2. Next, the doctor will access the aneurysm in your abdomen through the femoral arteries in your groin.

3. Using two very thin needles, a catheter , a thin, flexible tube, is inserted into these two arteries. The stent graft we mentioned earlier is folded inside this catheter.

4. While looking at a special X-ray-like screen, the doctor guides this catheter along the blood vessel to the location of the aneurysm.

5. Once in the exact right place, the stent tube inside the catheter is expanded. It then expands inside the blood vessel, creating a new, stronger path for blood to flow.

6. This stent tube is firmly attached to the wall of the blood vessel, preventing blood from entering the aneurysm.

7. After the procedure is complete, the catheter is carefully removed. The punctures are so small that stitches are not even needed. A small plaster is applied to the wound to help it heal.

How is the recovery time after surgery?

It usually takes a few days to a month for you to fully recover.

• You will have to stay in the hospital for two or three days.
• You can start eating and drinking immediately after anesthesia.
• You can even get out of bed and walk with the help of nurses.
• You may feel a little tired and sore for a few days after you go home. You should use the painkillers given to you properly.
• Avoid driving until you take the painkillers.
• Most people can return to work within a month.
• You should avoid lifting any heavy objects for 4 to 6 weeks.

EVAR, Endovascular Aneurysm Repair, Aneurysm, Aorta, Stent Graft, Aneurysm, Stent, Heart Disease, Surgery, Aorta