Endovascular aneurysm repair

Endovascular Aneurysm Repair (EVAR) is a minimally invasive type of surgery used to treat aneurysms, particularly those occurring in the aorta, the largest artery in the body. This procedure is an alternative to the traditional open surgery used to repair aortic aneurysms. It involves the placement of an endovascular stent graft within the aorta to support the artery's walls and prevent the aneurysm from rupturing.

Overview

An aortic aneurysm is a bulging or ballooning in the wall of the aorta. Aneurysms can occur anywhere along the aorta, but they are most common in the abdominal section, known as an abdominal aortic aneurysm (AAA), and less commonly in the thoracic section, known as a thoracic aortic aneurysm (TAA). The primary goal of EVAR is to prevent the aneurysm from rupturing, which can lead to life-threatening internal bleeding.

Procedure

EVAR is performed using catheters that are inserted into the blood vessels through small incisions in the groin. These catheters are used to guide the stent graft to the site of the aneurysm. Once in place, the stent graft is expanded to fit against the walls of the aorta, creating a new path for blood flow and relieving pressure on the aneurysm. The procedure is typically performed under general anesthesia and requires monitoring in the hospital for a short period after the surgery.

Advantages and Disadvantages

The main advantage of EVAR over open surgical repair is the reduced recovery time and lower risk of complications. Patients typically experience less pain and can return to normal activities more quickly than with open surgery. However, EVAR may not be suitable for all patients, particularly those with aneurysms that are not shaped in a way that can accommodate a stent graft. Additionally, patients undergoing EVAR may require regular imaging tests to ensure the stent graft remains properly positioned and the aneurysm is not continuing to expand.

Risks and Complications

While EVAR is generally considered safer than open surgery, it is not without risks. Complications can include endoleaks (where blood leaks around the outside of the graft), migration of the stent graft, infection, and damage to surrounding blood vessels. Regular follow-up is essential to monitor for these potential complications.

Conclusion

Endovascular aneurysm repair represents a significant advancement in the treatment of aortic aneurysms, offering patients a less invasive option with a quicker recovery time. However, it is important for patients to discuss the risks and benefits of EVAR with their healthcare provider to determine the best treatment plan for their individual condition.

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Endovascular_aneurysm_repair

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  Endovascular aneurysm repair procedure

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  Endovascular stent graft

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  Fenestrated graft for aneurysm repair

• Artist's depiction of fenestrated branch in situ