Endovascular Aortic Aneurysm Repair (EVAR, TEVAR)
In recent years, endovascular techniques have become a frequently discussed option for treating aortic aneurysms. Offering greater patient comfort and satisfaction compared to traditional surgery, this method is successfully performed in many centers in our country. Through a small incision in the patient’s groin, a thin catheter is inserted into the aorta. Using this catheter, a synthetic graft mounted on a fine metal mesh (stent), known as an endovascular graft, is advanced to the aneurysm site and positioned so that both ends rest on healthy tissue. This completely separates the blood flow from the aneurysm sac. The procedure is usually performed under light general or local anesthesia, and since no body cavity is opened, it is easily tolerated by patients.
Which Patients Should Undergo Treatment?
The mere presence of an aneurysm should alert both the patient and the attending physician. If an aneurysm is diagnosed before reaching a critical size, the usual approach is to optimize the patient’s medical therapy and monitor the aneurysm’s size at regular intervals. Although absolute treatment criteria (surgical or endovascular) vary depending on the aneurysm’s location, an average diameter of 5 cm is generally considered the threshold. Aneurysms exceeding this threshold should be treated.
At this point, several patient-specific factors help determine the most suitable treatment option: the patient’s age, the shape and size of the aneurysm, its proximity to vessels supplying vital organs, the patient’s overall physical condition, the presence of other medical conditions, and lung function. These factors are discussed with the patient to decide on the most appropriate treatment strategy.
Nasıl yapılır?
Proper patient selection and careful procedural planning are key factors for the success of the intervention. Therefore, before the procedure, a 3D computed tomography (CT) scan and angiography are performed to determine whether this method is suitable for treating the specific aneurysm.
Under mild general anesthesia or spinal anesthesia, small incisions are made in one or both groin areas to access the femoral artery. Through this artery, wires and catheters are advanced into the blood vessel to deliver the endovascular graft to the aneurysm site.
These steps are guided by fluoroscopy (real-time X-ray imaging) to visualize the wires and graft. The endovascular graft is then deployed within the aneurysm, covering the aneurysm sac while anchoring securely in the healthy vessel segments at both ends. The graft contains metal hooks at each end and a stent structure along its body to firmly attach to the vessel wall.
Once in place, the graft isolates the aneurysm from normal blood flow, eliminating the most dangerous risk—rupture of the aneurysm—and significantly reducing the risk of life-threatening bleeding.
Post-Procedure Care
After the treatment, patients usually stay in the hospital for a few days for monitoring. Depending on the type of anesthesia used, the patient can eat and move around shortly after the procedure. Generally, patients can start driving within one to two weeks. During the first six weeks post-procedure, patients are advised not to lift heavy objects (over 2–3 kg) to ensure proper healing.
Follow-Up
After endovascular procedures, unwanted events, known as complications, can occur. These may include the graft shifting from its anchoring point, blood flow resuming around the graft (endoleak), graft infection, or blockage in one of the graft limbs. For this reason, patients need to have regular follow-up check-ups throughout their lives.
Since this method has been widely used for the past 10–15 years, long-term outcome data continue to accumulate. Most patients can return to a normal life after the procedure. However, because the factors that lead to aneurysm formation are also associated with cardiovascular disease, patients are advised to adopt a healthy lifestyle, quit smoking, and maintain regular exercise.
Endovascular Aortic Aneurysm Repair (EVAR, TEVAR)
“We frequently hear about endovascular techniques as a treatment option for aortic aneurysms in recent times.”
Endovascular Aortic Aneurysm Repair (EVAR, TEVAR)
This method, which offers greater patient comfort and satisfaction compared to surgical treatment, is successfully performed in many centers across our country.