Endovascular Aortic Repair (EVAR)
Date issued: November 2024
For review: November 2026
Ref: B-293/Imaging/RA/Endovasular Aortic Repair (EVAR) v2
PDF: Endovascular Aortic Repair (EVAR).pdf [pdf] 217KB
This leaflet tells you about having an endovascular aortic repair (EVAR). It explains what is involved and what the possible risks are. It is not meant to replace informed discussion between you and your doctor but can act as a starting point for such discussions. If you have any questions about the procedure, please ask the doctor who has referred you or the department which is going to perform it.
Referral and consent
The referring clinician should have discussed the reasons for this examination with you in the clinic and you should make sure that you understand these before attending. Before the procedure you will need to sign a consent form, if one hasn’t previously been completed. This form says that you need to know what risks are involved. This is a legal requirement and ensures that you are fully informed about your procedure.
If after discussion with your hospital doctor or Interventional Radiologist (a doctor who has trained and specialised in imaging and x-ray treatments) you do not want this examination, then you can decide against it. At all times the Interventional Radiologist and referring clinician will be acting in your best interests.
What is an EVAR?
Endovascular aortic repair (EVAR) is a way of repairing an abnormality in the main blood vessel in the tummy (aorta) by inserting covered metal mesh tubes (stent grafts).
Stent grafts are typically inserted in a minimally invasive manner via the arteries in your groin using
X-ray guidance to position them accurately. It is an alternative procedure to the conventional open surgical repair of the abdominal aorta.
Why do you need an EVAR?
You will have already had imaging, either a computed tomography (CT) or a magnetic resonance imaging (MRI) scan, to look at the aorta in your abdomen. The tests have shown that the aorta in your abdomen is enlarged and has developed an aneurysm. The size of the aneurysm is such that there is a risk of it bursting (rupture). This is a very serious problem, and most people will not survive a rupture. Repairing the aorta before it ruptures usually has good results. Repair can either be done with a major surgical operation to replace the abdominal aorta with a ‘plastic tube’ or the aorta can be ‘relined’ from the inside with a stent graft. Both procedures work well, with EVAR being a less significant procedure. Not all patients with an aneurysm are suitable for EVAR, but imaging has shown that yours is.
Are there any risks?
EVAR is a major but normally safe procedure. There are a number of risks and complications that can arise. They are relatively rare; some are less than a major surgery, others are about the same.
There can be damage to the blood vessels through which the tubes are placed or damage to the aneurysm causing a leak. This may require other radiological procedures or conversion to a major surgical repair.
Occasionally, because of the size of your blood vessels, it may not be possible to insert the stent graft satisfactory and surgical conversion may also be required. These complications are uncommon.
The stent graft may not completely seal the aneurysm, allowing it to continue to fill. Small leaks are quite common and usually require no additional treatment. Some larger leaks may require a further procedure/operation to seal them (approximately 1 in 5 or less).
Other complications include wound or graft infection, acute kidney injury, blood clots (DVT/PE) and graft blockage. Blockage of the arteries to the legs can occur, resulting in an operation and very rarely leg amputation may occur. Some complications can be life threatening and although rare, death should also be considered as a risk of this procedure.
There are small risks related to the anaesthetic which will be explained to you by your anaesthetist.
If you are pregnant or suspect that you may be pregnant you should notify the department. A baby in the womb may be more sensitive to radiation than an adult. There is no problem with something like an x-ray of the hand or chest because the radiation field is at a safe distance from the foetus. However, special precautions are required for examinations where the womb is in, or near, the beam of radiation. If you are a female of childbearing age the radiographer will ask you if there is any chance of you being pregnant before the examination begins and you will be asked to sign a form. If there is a possibility of pregnancy, then your case will be discussed with the team looking after you to decide whether or not to recommend postponing the investigation.
There will be occasions when diagnosing and treating your illness is essential for your health and where the benefit clearly outweighs the small radiation risks. The procedure may go ahead after discussing all the options with you.
Are you required to make any special preparations?
You need to be an inpatient for the procedure.
If you have a morning appointment, you will be asked to have nothing to eat from midnight although you may still drink water up to 6am then sips of water for the 2 hours before your examination.
If you have an afternoon appointment you may eat normally up to 6am and then water only up to 10am with sips of water for the 2 hours before your examination.
If you are taking warfarin, rivaroxaban, apixaban, ticagrelor (anticoagulants) this will be stopped before the procedure and you may require admission to hospital to give you an alternative.
If you have any allergies or have previously had a reaction to the dye (contrast agent), you must tell the radiology staff before you have the test.
The procedure can be carried out with a variety of anaesthetic techniques ranging from a full general anaesthetic to a needle in your back to numb your lower body (spinal). The anaesthetist will explain the various options and risks.
Who will you see?
A team of doctors, including a vascular surgeon and a specially trained doctor, called an Interventional Radiologist, performs the procedure. Interventional Radiologists have special expertise in reading the images and using imaging to guide catheters and wires to aid diagnosis and treatment.
Where will the procedure take place?
You will be admitted to a ward prior to the procedure. You will be asked to get undressed and put on a hospital gown. A small cannula (thin tube) will be placed into a vein in your arm. You may require a fluid drip to help your kidney function before the procedure. Our porters will collect you and bring you to the interventional radiology suite which is located within
X-ray East. This is similar to an operating theatre into which specialised X-ray equipment has been installed.
What happens during an EVAR?
Before the EVAR, the vascular surgeon and Radiologist will explain the procedure and ask if you have signed a consent form, if one hasn’t been previously completed. Please feel free to ask any questions that you may have and, remember that even at this stage, you can decide against going ahead with the procedure if you so wish.
Anaesthetic type will be decided between you and your anaesthetist.
The procedure is performed under sterile conditions and the Interventional Radiologist and a vascular surgeon will wear sterile gowns and gloves. Small incisions are made in your groin to expose the artery. Once the artery is exposed within the groin, a special guide wire and catheter (fine plastic tube) will be inserted into the artery and guided to the correct position to obtain the images required. The stent graft is introduced from the groin and positioned using the X-ray equipment; dye (contrast agent) is injected into the blood vessels to check the position. Once the aneurysm is satisfactorily excluded, the tubes and wires are removed and the arteries in the groin closed with special stitches/special closure devices.
Will it hurt?
There may be a little discomfort related to the groin incisions for a few days afterwards. This usually settles quickly and can be controlled with painkillers. You will not feel the stent graft inside you.
How long will it take?
Every patient is different, and it is not always easy to predict; however, on average the anaesthetic and procedure will take two or three hours.
What happens afterwards?
You will be returned to theatre recovery to recover from the anaesthetic and then back to your ward for close observation for approximately 24 hours. You should be fit for discharge after 3–5 days.
There is a small chance that your aneurysm will continue to fill after a stent graft is inserted or the graft may move. It is, therefore, important that this is checked regularly with CT, MRI or U/S imaging. The first scan will be soon after the insertion with increasing intervals thereafter.
Other Risks
EVAR is a major but normally safe procedure but as with any procedure or operation complications are possible. We have included the most common risks and complications in this leaflet.
We are all exposed to natural background radiation every day of our lives. This comes from the sun, food we eat, and the ground. Each examination gives a dose on top of this natural background radiation.
Any exposure to ionising radiation (e.g. X-rays) has the potential to cause cancer later in life. This is much lower than the risk we all have of developing cancer in our life of ~1 in 3 and will be considered by the doctor before your procedure.
For information about the effects of X-rays read the publication: “X-rays how safe are they” on the Health Protection Agency
Finally
Some of your questions should have been answered by this leaflet but remember that this is only a starting point for discussion about your treatment with the doctors looking after you. Make sure you are satisfied that you have received enough information about the procedure.
Contact
Interventional Radiology Department
01752 432063 – Bookings Clerk
01752 430838 – IR Co-ordinator
Additional Information
Bus services:
There are regular bus services to Derriford Hospital. Please contact:
Car parking:
Hospital car parking is available to all patients and visitors. Spaces are limited so please allow plenty of time to locate a car parking space. A charge is payable.
Park and Ride:
Buses (1/1A/42C/34) run from the George Junction Park and Ride Mon-Sat (except Bank Holidays) every 15/20 mins from 6am. The last bus leaves the hospital at 11:30pm.
Plympton Park and Ride (52) runs from Coypool Park and Ride.
Parking is free although you will need to purchase a ticket to travel on the bus.
Patient Transport:
For patients unable to use private or public transport please contact The Patient Transport Service:
Devon GP: 0345 155 1009
Cornwall GP: 01872 252211
Comments and Suggestions
We welcome comments and suggestions to help us improve our service.
