Endovascular Aortic Aneurysm Repair
Women’s aortas may be smaller and more difficult to access than men’s, and so fewer may be eligible for endovascular aortic aneurysm repair (EVAR). However, women treated with EVAR do as well as men following the procedure.
EVAR is a procedure in which an aneurysm is repaired from inside the aorta. It is a minimally invasive procedure that involves guiding a stent graft into the aorta and placing it into the area of the aneurysm. Blood flow is diverted through the graft and, as pressure decreases against the walls of the aorta, the aneurysm recedes.
Because EVAR is much less invasive (the incision is much smaller and less penetrating) than traditional open aortic aneurysm surgery repair, it has been shown to have more short-term benefits, such as decreased length of hospitalization, reduced intensive care unit stays, less blood loss, fewer major complications and faster recovery.
What to Expect:
- No eating or drinking for 8 hours before EVAR.
- You’ll be sedated to a “twilight sleep” or may receive general anesthesia.
- You’ll have a single, small incision.
- You’ll recover in the hospital for 2 to 3 days.
- You’ll need anticoagulant medication and follow-up scans.
Preparing for EVAR
A few days before your EVAR is scheduled, you will visit the hospital for blood tests, a chest x-ray and an electrocardiogram, all of which will give your doctors and technicians information to help them plan your procedure. A nurse or technician will also explain the risks of the test and give you a consent form to sign. You will be asked not to eat or drink anything for eight hours before your catheterization. You will also discuss whether you would rather have the procedure with general or local anesthesia.
When you arrive at the hospital, you will be given an identification bracelet and a hospital gown to wear during the procedure. A technician will ask you a few questions and may take your blood pressure. The staff will take you into a catheterization laboratory or “cath lab” and help you onto the examination table. You’ll be greeted by the doctor who will be performing your test and the staff who will be assisting. One of the staff will place electrodes on your chest that will be connected to the machine that will monitor your heart function. An attendant will insert a needle connected to a flexible tube, or IV line, into your arm and will use an antiseptic to cleanse an area of your groin where the catheter will be inserted.
The area will be numb and you’ll be in a twilight sleep or a deep sleep, depending on the type of anesthesia you selected. The doctor will make a small incision in one of the femoral arteries, which connect the vessels of the leg to the aorta. He or she will insert a thin guidewire into the artery, thread it up into the aorta and insert the catheter over it. After the catheter is in place, a radioactive dye will be infused into it to outline the aorta on the monitor.
Your doctor will then make an incision in the other femoral artery and guide a second wire into the aorta. He or she will then insert an expandable synthetic stent into the catheter and, using both wires, guide it into place in the aorta. A balloon catheter may be inflated inside the stent to expand and smooth it.
When the doctor has completed the procedure, the team will remove the catheters, the guidewires, the IV line and the electrodes connecting to the heart monitor. They will put a pressure bandage on the area where the catheters were inserted and a small bandage on your arm where the IV has been. You will be helped onto a comfortable, bed-like gurney and wheeled into a recovery room. There, nurses will watch over you, taking your heart rate and blood pressure from time to time, until the anesthesia has worn off.
Following Your Procedure
Your recovery time for EVAR will be shorter than it would be had you undergone open surgery. Your hospital stay may be reduced to two to three days.
The surgical team will give you detailed instructions for follow-up care. You will probably schedule follow-up CT scans to determine whether your stent is functioning properly. You may be prescribed an anticoagulant medication to prevent clots from forming on the stent.
Date Last Modified: January 21, 2011
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