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Endovascular repair is a procedure to fix an aortic aneurysm in the abdomen. It's called endovascular because a doctor repairs the aneurysm from the inside of the damaged blood vessel (the aorta).
This procedure is relatively new compared to the traditional open surgery to repair an aneurysm. It is a minimally invasive procedure. Local or general anesthesia might be used.
The doctor will make one or two cuts (incisions) in the groin area. Small flexible tubes, called catheters, are inserted into arteries in the groin area. The doctor puts dye into the arteries. The dye will make your aorta show up on X-ray pictures during the procedure.
The doctor uses the catheters to move a man-made tube, called a stent graft, through the arteries until it reaches the aorta. The doctor expands the graft inside of the aneurysm. Then the doctor attaches the graft to the blood vessel. When the graft is in place, the doctor will take out the catheters and the wires. He or she will use stitches to close the incisions in the groin area.
After the procedure, blood passes through the graft in the aorta without pushing on the aneurysm.
You will probably spend 1 to 3 days in the hospital. You can expect the cuts (incisions) in your groin to be sore for 1 to 2 weeks.
You may feel more tired than usual for 1 to 2 weeks after the procedure. You may be able to do many of your usual activities after 1 to 2 weeks. But you will probably need up to 4 weeks to fully recover. You may need to take at least 1 to 2 weeks off from work. It depends on the type of work you do and how you feel.
You will need regular
tests, such as a CT scan or ultrasound, to check for problems with the graft.1 You might have the test one or more times in the first year after this procedure. Then you will have a test once a year for the rest of your life.2
Repairing an aortic aneurysm is typically recommended if the aneurysm is at risk of bursting open (rupturing). Aortic aneurysms that
are large, are causing symptoms, or are rapidly getting bigger are considered at risk of rupturing.
In men, repair is typically recommended for
an abdominal aortic aneurysm that is 5.5 cm or larger
in diameter. In women, repair may be recommended for smaller aneurysms.3
Your doctor will work with you to decide which type of repair surgery—open or endovascular—is right for you. Your doctor will check:1
When an aortic aneurysm is at risk of rupturing, or bursting open, the benefits of repairing the aneurysm can outweigh the risks. Repairing the aneurysm lowers the risk of rupture and can help a person live longer. Repairing a smaller aneurysm, which doesn't have as high a risk of rupture, does not help a person live longer.4
Overall, open repair surgery and endovascular repair have similar outcomes and long-term benefits.1
An endovascular repair isn't an open surgery. So it doesn't have the risks or complications of a major surgery, and the recovery time is shorter. But there is a higher risk that you will need another procedure or surgery.5
The risk of dying during or soon after an endovascular repair is lower than the risk from open surgery. For an endovascular repair, about 1 out of 100 people die during surgery or within 30 days after surgery.6 But after a few years, people who have open surgery live as long as people who had endovascular repair.7 Experts are still studying the long-term effects of endovascular repair.
Complications include bleeding, infection, and problems with the stent graft. A common complication is a leak around the stent graft. About 15 out of 100 people have a problem that requires a second procedure or surgery.8
When making a decision about repairing an aortic
aneurysm, you and your doctor will consider the benefits compared to the risks. For some people, the endovascular repair procedure isn't possible, but open repair surgery might be an option.
The U.S. Food and Drug Administration (FDA) gave a premarket approval
application to stent grafts in 1999. In 2001, the FDA issued a Public Health
Notification for two of these devices: the Ancure System (Guidant) and the
AneuRx System (Medtronic AVE). Placement problems, which were associated with
damaged artery walls, were reported for the Ancure System. Problems such as
leaking, slipping out of place, suture breaks, fabric tears, and poor graft
placement were reported for the AneuRx system. Because only a small number of
people with these devices have had these problems, the devices remain in use.
But the Ancure System has not been made since 2003. If you have one of these systems implanted, talk to your doctor.
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Rooke TW, et al. (2011). 2011 ACCF/AHA Focused update of the guideline for the management of patients with peripheral artery disease (Updating the 2005 guideline): A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology, 58(19): 2020–2045.
Braverman AC, et al. (2012). Diseases of the aorta. In RO Bonow et al., eds., Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine, 9th ed., vol. 2, pp. 1309–1337. Philadelphia: Saunders.
Hirsch AT, et al. (2006). ACC/AHA 2005 practice guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): A collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, So
Eliason JL, Upchurch GR Jr (2008). Endovascular abdominal aortic aneurysm repair. Circulation, 117(13): 1738–1744.
De Bruin JL, et al. (2010). Long-term outcomes of open or endovascular repair or abdominal aortic aneurysm. New England Journal of Medicine, 362(20): 1881–1889.
Lederle FA, et al. (2009). Outcomes following endovascular vs open repair of abdominal aortic aneurysm: A randomized trial. JAMA, 302(14): 1535–1542.
United Kingdom EVAR Trial Investigators (2010). Endovascular versus open repair of abdominal aortic aneurysm. New England Journal of Medicine, 362(20): 1863–1871.
Chaikof EL, et al. (2009). Care of patients with an abdominal aortic aneurysm: Society for Vascular Surgery practice guidelines. Journal of Vascular Surgery, 50(4, Suppl): S2–S49.
February 22, 2012
E. Gregory Thompson, MD - Internal Medicine & David A. Szalay, MD - Vascular Surgery
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