EVAR (Endovascular Aortic Repair)
EVAR is a minimally invasive endovascular procedure that seals a large abdominal aortic aneurysm from inside the blood vessel by deploying a stent graft through the femoral arteries — preventing life-threatening aneurysm rupture without the need for open abdominal surgery.
Overview
EVAR deploys a fabric-covered metal stent graft system through bilateral femoral artery access, advanced under fluoroscopic guidance to precisely position across the aortic aneurysm. The modular graft seals against the normal aorta above and the iliac arteries below, excluding the aneurysm sac from systemic blood pressure and preventing further expansion or rupture. EVAR offers dramatically reduced peri-operative mortality and morbidity compared to open aortic repair, making it the preferred approach for anatomically suitable aneurysms in patients with significant cardiac or respiratory comorbidity. Long-term EVAR surveillance with annual CT imaging is essential to detect endoleak and graft migration.
Types of EVAR
EVAR has expanded to address aortic aneurysms involving the renal and visceral vessels with fenestrated and branched devices.
- Standard EVAR (bifurcated stent graft for infrarenal AAA — most common)
- FEVAR — Fenestrated EVAR (custom devices for juxtarenal or pararenal aneurysms)
- BEVAR — Branched EVAR (for thoracoabdominal aneurysms involving visceral vessels)
- TEVAR — Thoracic EVAR (for thoracic aortic aneurysm or dissection)
- Ruptured AAA EVAR (emergency EVAR for contained rupture in anatomically suitable patients)
Risk Factors for Abdominal Aortic Aneurysm
AAA has strongly identifiable modifiable and hereditary risk factors that explain its epidemiology and guide screening strategies.
- Smoking — the single most powerful modifiable risk factor for AAA formation and growth
- Male sex — AAA is 5 times more common in men than women
- Age above 65 years — peak incidence
- Family history — first-degree relatives have a four-fold increased risk
- Hypertension and hyperlipidaemia contributing to aortic wall degeneration
- Atherosclerosis — AAA frequently co-exists with coronary and peripheral arterial disease
AAA Symptoms Requiring EVAR Assessment
Most AAAs are asymptomatic and detected incidentally or by ultrasound screening. These features indicate significant aneurysm requiring specialist vascular surgery evaluation.
- Pulsatile abdominal mass on clinical examination
- Incidental finding of aortic dilatation on ultrasound, CT, or MRI
- Aortic diameter above 5.5 cm in men or 5.0 cm in women — threshold for elective repair
- Rapid expansion greater than 1 cm per year regardless of current diameter
- Symptomatic AAA — back or flank pain suggesting impending rupture requiring urgent repair
- Ruptured AAA — haemodynamic instability with back pain — emergency EVAR or open repair
- Iliac artery aneurysm co-existing with AAA requiring combined treatment
- Inflammatory AAA causing periaortic fibrosis with ureteric obstruction
Key Benefits
Discover the advantages of choosing our evar (endovascular aortic repair) services.
Dramatically reduced peri-operative mortality compared to open aortic aneurysm repair
Short hospital stay of 2 to 3 days versus 7 to 10 days for open surgical repair
General or spinal anaesthesia both suitable — expanding candidacy to higher cardiac risk patients
No abdominal incision or aortic cross-clamp — the main determinants of open repair morbidity
Same-day ambulation with rapid return to full activities within 2 to 3 weeks
Clinical Features
The technology, techniques and clinical approach behind our evar (endovascular aortic repair).
Precise pre-operative CT planning with automated sizing software optimises stent graft selection
Fluoroscopic proximal deployment positioning preserves both renal arteries below the seal zone
Real-time fluoroscopic guidance throughout main body, gate catheterisation, and limb deployment
Completion angiogram in multiple projections excludes all endoleak types before sheath removal
Percutaneous or surgical femoral closure confirmed watertight before recovery room transfer
Preparation Instructions
After EVAR, the most important post-operative requirement is lifelong annual CT surveillance imaging to detect endoleak (continued blood pressure on the sac), graft migration, or limb kinking that could lead to late aneurysm rupture. Never miss your CT surveillance scans — the durability of EVAR depends on early detection and treatment of device-related problems. Control blood pressure rigorously, stop smoking permanently, and continue prescribed antiplatelet and statin therapy. Contact your vascular surgery team immediately for new back or abdominal pain, which may indicate late endoleak or aneurysm expansion.
The Procedure
Step-by-step guide to what you can expect during your evar (endovascular aortic repair) procedure.
EVAR Planning CT and Device Sizing
Your interventional vascular surgeon performs precise EVAR planning on the CT dataset — measuring neck diameter, neck length, angulation, iliac artery diameters, and access vessel tortuosity to select the optimal stent graft configuration and confirm anatomical suitability for standard EVAR.
General or Spinal Anaesthesia and Bilateral Groin Access
Anaesthesia is administered and bilateral groin incisions expose both common femoral arteries. Large-bore introducer sheaths are placed over guide wires under fluoroscopic guidance, establishing the bilateral femoral access routes for the main body and contralateral iliac limb delivery.
Main Body Deployment Under Fluoroscopy
The main body of the stent graft is advanced over a stiff guide wire to the infrarenal aorta and deployed under fluoroscopic guidance — positioning the proximal edge precisely below the lowest renal artery while maintaining accurate orientation for the contralateral gate alignment.
Contralateral Limb Catheterisation and Deployment
The contralateral iliac limb gate is catheterised from the opposite femoral access, a wire is advanced through the gate, and the contralateral iliac limb is delivered and deployed — telescoping into the main body to create a complete sealed bifurcated repair.
Completion Angiogram and Endoleak Assessment
A completion angiogram in multiple projections confirms the stent graft is fully deployed, the aneurysm sac is excluded from systemic pressure, all renal arteries are patent, and no endoleak is present — type I and III endoleaks are treated immediately before sheath removal.
Access Closure and Recovery
The femoral access sites are closed with vascular sutures or percutaneous closure devices and you recover in the vascular surgery ward. Most patients are mobile the morning after surgery and discharged within 2 to 3 days.
What to Expect
EVAR is performed under general or spinal anaesthesia and takes 1.5 to 2.5 hours. Bilateral small groin incisions access the femoral arteries, the stent graft system is advanced over guidewires to the aorta under fluoroscopic guidance, and the main body and iliac limbs are deployed with precise positioning relative to the renal arteries confirmed by intraoperative angiography. A completion angiogram confirms no endoleak before sheath removal and groin closure. Most patients mobilise the next morning and are discharged within 2 to 3 days.
Frequently Asked Questions
Common questions about evar (endovascular aortic repair).
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