EVAR for Abdominal Aortic Aneurysm in Singapore

Endovascular aneurysm repair, or EVAR, treats a suitable abdominal aortic aneurysm by placing a fabric-covered stent inside the artery. Blood flows through this new channel, reducing pressure on the weakened aneurysm wall. The aneurysm is usually left in place. EVAR avoids a large abdominal incision, but it is still a major vascular procedure and needs long-term follow-up.

When might EVAR be considered?

The first question is whether an aneurysm needs repair at all. Symptoms, size, growth, shape and the risk of rupture are weighed against the risks of an operation and your overall health. A smaller, stable aneurysm may be better managed with surveillance and cardiovascular risk treatment. The aortic disease guide explains the diagnosis and warning symptoms.

If repair is appropriate, CT angiography helps assess the healthy artery above and below the aneurysm, the arteries supplying the kidneys, and the route through the pelvis and groins. Standard EVAR generally needs a suitable sealing area below the kidney arteries. Angulation, narrowing, calcium or a short sealing segment may make a standard device unsuitable.

How does standard EVAR differ from complex repair?

Standard EVAR is designed for an aneurysm that can be sealed without covering important abdominal organ arteries. An aneurysm reaching the kidney or intestinal arteries may need fenestrated or branched repair, or open aortic surgery. These procedures have different planning requirements and risks. A small skin incision does not make all endovascular repairs equivalent.

Dr Choong's EVAR video and article describe the idea of a new channel within the existing artery. Your own scan determines whether that principle can be applied safely.

What does assessment and treatment involve?

Preparation includes reviewing kidney function, heart and lung health, medication, mobility and previous operations. Tell the team about contrast reactions and bring your medication list. Any changes to anticoagulants, diabetes medicines or other prescriptions should come from your treating team.

During EVAR, the team introduces the stent graft through the groin arteries using small incisions or punctures and positions it with imaging. The graft is checked for a seal and blood flow to the legs and important branches. Anaesthesia and the access method depend on the procedure and your health. Additional treatment or conversion to open surgery may occasionally be necessary.

What benefits and risks should I compare?

For suitable patients, EVAR can reduce the early physical burden of repair and often allows a faster initial recovery than open surgery. The trade-off includes device-related problems, repeat imaging and the possibility of further procedures. It does not remove all future aneurysm risk.

• Bleeding, access-artery injury, wound problems or infection.
• Heart, lung or kidney complications, including a possible need for dialysis.
• Reduced blood flow to the legs, bowel or pelvic circulation; some patients develop sexual-function problems.
• Endoleak, graft movement or blockage, aneurysm enlargement, further intervention, rupture or death.

The likelihood of these problems differs between elective and emergency repair and between patients. Ask how your own anatomy, frailty and other illnesses change the balance. When intervention offers little likely benefit, a conservative plan remains a legitimate choice.

What happens after EVAR?

Hospital monitoring checks circulation, access wounds, kidney function and general recovery. Walking increases gradually. Your team should give individual instructions about lifting, driving, work, wound care and medication before discharge; a fixed return-to-normal date is not reliable for everyone.

You will need a written imaging plan. Scans check the aneurysm sac, graft position, seal and blood flow. Feeling well cannot confirm that the graft is working normally. Read about aortic stent surveillance and endoleaks, and use the aortic awareness guide to organise your continuing care.

Common questions about EVAR

Does EVAR cure the aneurysm permanently?

Its aim is to prevent rupture, but later changes can occur. Some people need another endovascular procedure or open repair. Long-term follow-up remains part of treatment.

Is EVAR always better than open repair?

No. Anatomy, expected durability, age, fitness, previous surgery and your preferences all matter. A discussion should include both approaches when appropriate, and the option of continued surveillance.

Discuss an aneurysm repair plan in Singapore

For a planned assessment or second opinion with Dr Andrew Choong at Mount Elizabeth Novena Specialist Centre, contact the clinic. Bring current and previous scan images and reports, medication details and any proposed treatment plan.

Sudden severe abdominal, back or chest pain, collapse or new weakness needs emergency assessment. In Singapore, call 995; do not wait for a clinic reply.