Endovascular Aneurysm Repair (EVAR)

Abdominal aortic aneurysms usually require aneurysm repair if they reach a size when rupture becomes a real risk. This is about 5.5 cm for a male and 5 cm for a female. If you have back or abdominal pain or your aneurysm is growing quickly, your care team may recommend repair for smaller aneurysms.

When your care team is deciding on surgery versus endovascular repair, they use these considerations:

• Anatomy of the aneurysm — especially how close it is to the kidneys
• Your age
• Your general health
• Your symptoms

Any other health issues you may have — particularly heart issues In general, endovascular repair is particularly beneficial if you fall into these categories:

• Are over age 65
• Are at risk because of other medical conditions
• Have had previous abdominal surgery

Our Aortic Center helped pioneer the latest version of endovascular abdominal aortic aneurysm repair. Total percutaneous abdominal aortic aneurysm (AAA) repair not only avoids the need for an abdominal incision, but also prevents the need to cut into the groin. Instead, vascular surgeons make a small puncture in the skin on each side of the groin to gain access to the aneurysm.

Candidates for Total Percutaneous Abdominal Aortic Aneurysm Repair

The vast majority of those having endovascular abdominal aortic aneurysm (AAA) repair here receive this newer procedure. You will be a candidate for this type of repair even if you have these conditions:

• Arterial calcifications (buildup)
• Obesity
• Previous groin surgery
• Previous use of a closure device
• Small arteries

We perform endovascular and open abdominal aortic aneurysm repair in the operating room (OR). Endovascular aortic aneurysm repair takes place in our special hybrid operating room. This a traditional operating room equipped with the latest image guidance technology that is only available at a few hospitals around the world.

In some cases, we can perform endovascular repair without using general anesthesia. Compared to open procedures, the endovascular approach offers several benefits:

• Less scarring
• Quicker recovery time
• Reduced postoperative wound infection rate
• Shorter hospital stays

Innovative Imaging for Endovascular Aneurysm Repair

State-of-the-art imaging technology called Vessel Navigator guides surgeons throughout endovascular procedures. This provides a precise view of your blood vessels and enables complex aneurysm repairs.

BIDMC helped develop Vessel Navigator, and we were one of the first medical centers in the world to use this technology. Today, our Aortic Center uses Vessel Navigator to guide nearly all endovascular procedures.

Customized, Fenestrated and Branched Stent Grafts

Our surgeons are leaders in developing custom-built stent grafts. These offer a precise treatment option for complex anatomy:

• Individually customized stent grafts
• Branched stent grafts
• Fenestrated stent grafts

Fenestrated stent grafts have special openings called fenestrations. We customize these to your unique anatomy. This allows blood to flow from the aorta to vital organs.

Our experience and positive outcomes using the newest stent grafts allow us to offer an endovascular approach to more people.

During the procedure, the surgeon inserts a catheter through small incisions (cuts) in the groin and/or arms. The surgeon places a device called a stent-graft through the catheter into the damaged section of the aorta. The stent-graft acts as a support to take pressure off the wall of the aorta. It also helps restore blood flow and prevent aneurysms from rupturing.

Expected Outcomes

The prognosis is excellent for those who have endovascular abdominal aortic aneurysm repair. The procedure has been shown to be safe and effective. You’ll continue to have regular imaging and checkups with your care team after your abdominal aortic aneurysm repair.