Endovascular Aneurysm Repair (EVAR & TEVAR)

The aim is to exclude an abdominal or thoracic aortic aneurysm from arterial pressure and so prevent rupture. It is offered for suitable abdominal aortic aneurysms, descending thoracic aneurysms and selected other aortic conditions where the anatomy allows a reliable seal. Repair is recommended when the risk of leaving the aneurysm untreated exceeds the risk of the procedure.

Suitability depends on:

• Aneurysm size, growth rate and any symptoms
• Neck and landing-zone anatomy
• Iliac artery access for the delivery system
• General health, including heart, lung and kidney function

Open repair may be safer or more durable when the anatomy is unsuitable for a stent graft. Age by itself does not decide the question; fitness for the procedure and the aneurysm's behaviour matter more.

EVAR

The graft is introduced through the femoral arteries and positioned across the abdominal aneurysm. Components join within the aorta and iliac arteries to seal above and below the aneurysm.

TEVAR

A thoracic stent graft is delivered through the groin and deployed within the chest aorta. Additional procedures may be needed when important branch arteries arise near the treatment zone.

Preparation centres on high-resolution CT planning, heart and lung assessment, kidney-function review and a frank discussion of open repair as the alternative. Bring a full list of medicines, blood thinners, supplements and allergies to the planning consultation. Fasting and medication instructions are provided in writing, and smoking cessation meaningfully improves outcomes.

CT angiography and graft selection

Detailed CT imaging measures the aorta, iliac arteries and branch vessels, and the surgeon selects a graft matched to the individual anatomy. Endovascular repair is only possible when there are secure landing zones above and below the aneurysm. Complex aneurysms involving branch arteries may require customised fenestrated or branched devices.

Through the femoral arteries in the groin, a compressed fabric-covered stent graft is advanced under X-ray guidance and deployed across the aneurysm. The stent graft creates a new pathway for blood and takes pressure off the weakened aneurysm wall. Anaesthesia ranges from local with sedation to general, and hybrid open-endovascular approaches are used in selected complex cases.

Hospital stay is usually shorter than after open repair, with monitoring of the access sites, kidney function and leg circulation. Lifelong imaging surveillance is essential, because the graft and the aneurysm sac can change over time. Cardiovascular risk factors still require active management after repair.

Endoleaks and surveillance

An endoleak is persistent blood flow outside the graft but within the aneurysm sac. Some endoleaks resolve on their own, while others require closer monitoring or further treatment. Regular lifelong imaging is required to check graft position, seal and aneurysm size.

• Access-vessel injury and bleeding
• Endoleak
• Graft movement, kinking or blockage
• Kidney injury from contrast
• Embolisation or limb ischaemia
• Spinal cord ischaemia in some complex thoracic repairs
• Conversion to open surgery
• Later reintervention

The profile of these risks varies with the aneurysm's extent and your health, and the surgeon will discuss the ones most relevant to you.

Continued surveillance is appropriate for smaller aneurysms whose rupture risk remains lower than the risk of repair. Open surgery is the established alternative when anatomy cannot provide a secure endovascular seal, when long-term durability is the overriding priority or when other aortic disease must be treated at the same time.

EVAR and TEVAR are less invasive than open repair, but they are not automatically the safer or more durable choice for every patient. Suitability depends on the shape of the aorta, the length and quality of the sealing zones, branch vessels and access arteries. The consultation should explain why the proposed graft is appropriate and what anatomical limitations may affect the result.

Lifelong imaging is required because the graft relies on continuing seals and may move, leak or alter as the aorta changes. Most surveillance findings do not require another procedure, but detecting a problem early often allows a simpler endovascular correction. Patients should understand the scan schedule, kidney and contrast considerations, and which new chest, back or abdominal symptoms require urgent assessment.

Yarra Vascular Surgeons plans and performs endovascular aneurysm repair with detailed anatomical work-up and structured postoperative surveillance, with open aortic surgery available within the same group when it is the better option.

EVAR and TEVAR can exclude suitable abdominal and thoracic aortic aneurysms through small groin punctures. Careful patient selection is central: a less invasive repair must still provide a secure seal, reliable branch-vessel circulation and acceptable long-term durability.