AAA - Endovascular repair (EVAR)

What is abdominal aortic aneurysm (AAA)?

Read our information page on Abdominal Aortic Aneurysm - Surveillance which contains an explanation of how aneurysms occur and how you will be investigated. You may have already had many of those tests.

If it has been recommended to you that your AAA should be treated with a surgical procedure, there are two surgical techniques that may be used. The choice between endovascular repair ("EVAR" - EndoVascular Aortic aneurysm Repair, a "keyhole" or minimally invasive technique) and conventional Open surgical Repair ("OR") surgery depends on a number of technical and patient factors and your Vascular Surgeon will advise which is most suitable in your case. 

EVAR has been used since the late 1990's and consists of "relining" the enlarged Aorta with an endovascular stent graft (a tube composed of fabric supported by a metal meshwork or stent). It has been performed in our hospital in Tallaght since the hospital opened in 1998. Endovascular means "inside blood vessels" and these stent grafts can be positioned through one or two small incisions in the groin. Endovascular treatments allow you to leave the hospital sooner and recover more quickly, with less pain and a lower risk of complications and death than traditional surgery, because the incisions are smaller. However, some of those having EVAR may require further surgical procedures over the next few years compared to those having open surgery.

Preparing for the Procedure

You must fast (nothing to eat or drink) from midnight on the night before your operation. If you are not already in hospital, you may be asked to attend on the morning of your planned surgery ("Day of Surgery Admission). You can read about this and other information about the Operating Theatres in Tallaght University Hospital on the TUH website.  

On the morning of surgery, we will confirm that a bed is available in the intensive care unit or the Post Anaesthetic Care Unit, if required, and you will be brought to the operating theatre.

The procedure is usually performed under epidural anaesthetic but may sometimes be performed using local anaesthesia injections only. Your anaesthetist may recommend a general anaesthetic in certain cases.

When you have been anaesthetised, your surgeon will make an incision in each groin. The endograft is introduced through these incisions (in two or more parts) and passed up inside your blood vessels into the aneurysm. It is assembled here under XRay guidance. You can view an animation of the procedure online (https://youtu.be/qUpXJBoAoWI)

 

After surgery

After the operation you may be observed in the intensive care unit or PACU overnight or for a few days. There will be tubes in your arm veins and arteries and a tube in your nose and bladder but these will be removed over the next few days as you recover.

You will sit out on a chair on the first day after your operation and slowly build up your mobility over the next few days. A physiotherapist will help you keep your chest clear and ensure that you are coughing effectively.

Most people are ready for discharge in 5 days or so but you might prefer to go to a nursing home for a further two weeks convalescence. We can help you arrange this - the sooner enquiries are made the better and ideally this should be planned before your admission.

After discharge

Poor appetite, lack of energy and disturbed sleep are common and will resolve over weeks or months. You may begin walking straight away but heavier activity should be introduced gradually after 4 to 6 weeks. You can expect to be back to normal by three months.

Complications

While every effort is made to avoid problems, serious complications occur in up to 15% of people having aneurysm surgery. These include:

  • breathing problems (pneumonia)
  • heart problems (heart attack or irregular heartbeat)
  • kidney problems (kidney failure requiring dialysis)

If these problems occur, they may be life-threatening and the risk of death following aneurysm repair is between 5 and 10%. Serious bleeding during or after surgery, wounds problems or deep venous clots are uncommon but do occur.

A fever for a few days is common after surgery and does not necessarily indicate a major problem.

Followup

You will be seen regularly in the OPD and will need regular scans every 6-12 months or so for the rest of your life.