EVAR for Aortic Aneurysms: A Pipe Within a Pipe

EVAR treats a suitable aortic aneurysm from inside the blood vessel using a stent graft. A useful way to picture it is a pipe within a pipe: blood flows through a new lining designed to reduce pressure on the weakened aneurysm wall.

In this video, I introduce endovascular aortic repair and explain why it has become an important option for some patients. It is less invasive than open repair, but the right choice depends on the aneurysm, your overall health and the need for long-term follow-up.

What is an aortic aneurysm?

The aorta is the body’s main artery. An aneurysm is an abnormal enlargement of part of that artery, associated with weakening of its wall. Many aneurysms cause no symptoms and are discovered during a scan performed for another reason or through screening.

The concern is rupture, which can cause life-threatening internal bleeding. However, finding an aneurysm does not automatically mean an operation is needed. Smaller aneurysms may be monitored, with decisions guided by their size, growth, symptoms and the balance of treatment risks. Read more about aortic aneurysms and aortic disease.

How does EVAR work?

During EVAR, a stent graft is introduced through the arteries in the groin and positioned inside the aorta using imaging guidance. Access may be through small punctures or small incisions, depending on the vessels and the planned procedure.

The graft has a supporting framework and a fabric covering. It forms a channel through which blood can flow, with seals above and below the aneurysm in suitable anatomy. The aneurysm remains outside the graft, so the operation does not simply remove the enlarged artery.

The aim is to exclude the aneurysm from the main blood flow and reduce its risk of rupture. Whether this can be achieved safely must be assessed before treatment.

Who may be suitable for EVAR?

A CT scan helps the vascular team evaluate the aneurysm and plan a repair. Important considerations include:

• The aneurysm’s location and shape: including its relationship to important branch arteries.

• Suitable sealing areas: where the graft can fit securely.

• Access through the groin arteries: their size, narrowing and tortuosity can matter.

• Your overall health: including kidney function, fitness and other medical conditions.

• Long-term care: including the ability to attend follow-up scans.

Some aneurysms need a more complex endovascular approach or open surgery. For others, continued surveillance is appropriate. These decisions form part of individual treatment planning.

How does EVAR compare with open repair?

For suitable patients, EVAR can offer a less demanding early recovery and lower short-term operative risk than open repair. Those early benefits do not mean it is the best option for everyone or that the aneurysm requires no further attention.

Open repair remains important. The discussion includes the expected benefits, procedural risks, durability and likelihood of needing further treatment. I would explain why an option fits your particular anatomy and circumstances rather than choose solely by the size of the incision.

Why are follow-up scans important?

After EVAR, scans check the graft’s position and whether the aneurysm remains effectively excluded. One issue they look for is an endoleak, meaning blood still reaches the aneurysm sac outside the graft. Some findings require monitoring; others may need another procedure.

Follow-up is therefore part of the treatment, even when you feel well. The schedule and type of scan depend on the repair and subsequent findings.

Should you discuss aneurysm screening?

In the video, I encourage people with a family history, and men over 55 particularly with smoking or high blood pressure, to discuss their risk. This is an invitation to an individual assessment, not a universal screening rule for everyone over 55. Screening recommendations vary by age, sex, smoking history and family history.

Ultrasound can assess the abdominal aorta when screening is appropriate. Sudden severe abdominal or back pain, especially with collapse, needs emergency care instead of a screening appointment. In Singapore, call 995 for a life-threatening emergency.

Aortic aneurysm assessment in Singapore

To discuss a known aneurysm or your screening risk, contact Andrew Choong Vascular Surgery at Mount Elizabeth Novena Specialist Centre, #09-22, 38 Irrawaddy Road, Singapore 329563.

This article provides general education and does not replace an individual medical assessment.