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Treatment / Endovascular Aneurysm Repair

Endovascular repair is a preferred treatment for many people with an abdominal aortic aneurysm (AAA), and offers an alternative for people who do not qualify for open surgery

Am I a Candidate for Endovascular Aneurysm Repair?

When you come in to be treated for an AAA, your doctor will talk to you about your medical history and perform diagnosis testing, which could include an abdominal ultrasound and/or a computed tomographic angiography (CTA). Imaging will help determine the optimal type of repair.

In deciding whether to recommend repair your Interventional Radiologist (IR) will consider the size of the aneurysm, its location, how fast it is growing, how complicated it is to repair and your overall health. There are two classifications depending on the location of the AAA:

  • Standard – aneurysm located below the arteries to the kidney
  • Complex – aneurysm affecting one or more of the important arteries that branch off the aorta

Candidates for endovascular aneurysm repair (EVAR) have aneurysms that meet the following criteria:

  • Diameter large enough (typically > 5.5cm) where the risk of rupture is greater than the risk of surgery
  • Rapidly enlarge or those that have been the source of emboli (debris from the aneurysm that dislodge and travel into other arteries)
  • The source of pain and tenderness, which may indicate impending rupture

What to Expect from the Procedure

When you come in for your EVAR, you will either have local anesthesia with sedation, or general anesthesia – whatever you and your Interventional Radiologist (IR) have discussed prior to the procedure. Your IR will make surgical incisions in the groin on both sides. Guided by x-ray images, a thin tube called a catheter is inserted and advanced to the aneurysm site. A guide wire and an expandable stent graft (fabric-covered wire frame) are advanced through the catheter. When it is positioned correctly, the stent graft is allowed to expand within the artery. The wire frame pushes against the healthy portion of the aorta to seal the graft in place. Once in place, blood will flow through the stent graft and can not enter the aneurysm.

The procedure usually takes 2 hours to complete and most patients will lave the hospital within a day.

Recovery

Unlike traditional open surgical repair, EVAR is minimally invasive, which can mean a shorter recovery time for most people. Patients can typically return to normal activities within a few weeks and will schedule a follow-up with their IR one month after the procedure.

As with any surgical procedure, there are risks. Complications associated with endovascular stent grafting include:

  • Blood leakages around the stent graft
  • Blockages of the flow of blood though the stent graft
  • Movement of the stent graft from its original location
  • Fracture of the stent graft
  • Infection
  • Rupture of the aneurysm or aorta

Endovascular stent grafting is not for everyone. Your aortic aneurysm may not have the right shape, or it may be too close to other organs. Your doctor or vascular surgeon will help you decide whether endovascular stent grafting is the best treatment option for you. Call IVC today at 503-612-0498 to schedule an appointment for a consultation.

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