Endovascular aneurysm repair (EVAR)

EVAR is a minimally invasive treatment for an abdominal aortic aneurysm (AAA). An AAA occurs when the aorta, the main artery supplying blood to the whole body, weakens and bulges outward. If untreated, an AAA can rupture, leading to critical internal bleeding.

Surgeons perform EVAR to lower the risk of rupture. They use a tube or stent made of fabric with a metal mesh frame to line the aneurysm, which helps reduce pressure and the likelihood of a rupture.

Compared to open surgery, EVAR offers less pain, better outcomes, and faster recovery. Penn Medicine surgeons handle some of the most complex aortic repair cases, with doctors from across the area referring people to us for advanced aortic surgery.

If you have a small aneurysm without symptoms, your doctor may suggest surveillance or watchful waiting. EVAR may be recommended if:

• The aneurysm is large or growing quickly.
• Open surgery isn’t a safe option for you.
• The blood vessel tissue near the aneurysm is healthy.

A vascular surgeon performs the EVAR procedure, which involves several key steps:

• The surgeon inserts a long, flexible tube (catheter) through a small puncture in your groin or arm.
• The catheter is then threaded through a blood vessel to reach the aneurysm.
• Using the catheter and specialized tools, the surgeon places a fabric tube (endograft stent) inside the aneurysm. This stent acts like a new pipe, reinforcing the weakened area and relieving pressure to prevent rupture.

EVAR recovery time can vary, but many people go home the next day. As you recover, you can return to your typical activities. You’ll likely feel like yourself again within about three weeks.

Although endovascular aortic repair is a minimally invasive procedure, you may still benefit from cardiac rehabilitation to help regain your heart health. Penn Medicine’s cardiac rehab is an outpatient program that includes exercise, nutrition, education, and support.

As with any surgical procedure, there are potential risks. These may include:

• Damage to nearby blood vessels, organs, or tissues
• Kidney damage
• Reduced blood flow to the legs or feet (limb ischemia)
• Groin wound infection
• Groin hematoma (blood clot)
• Bleeding
• Endoleak (continued bleeding into the aneurysm sac)
• Spinal cord injury

Penn Medicine is redefining heart and vascular care at every stage of disease with extraordinary expertise in minimally invasive aneurysm repair.

You’ll also find:

• Exceptional experience: Surgeons in our Vascular Surgery and Endovascular Therapy Program and Aorta Center treat some of the most complex cases of aortic repair. Providers across the southeastern Pennsylvania and New Jersey regions refer people to us for advanced aortic surgery.
• Care for complex cases: AAAs can be extremely complex if they involve arteries that feed the abdominal organs. Our vascular surgeons have access to advanced endovascular grafts not available everywhere.
• Excellent outcomes: As one of the nation’s leading centers for thoracic aortic, abdominal aortic, and carotid stent grafting, we’re among a handful of centers advancing endovascular surgery.
• Precise diagnosis: Knowing an abdominal aortic aneurysm’s exact location and extent is vital to your care. We use advanced testing to evaluate your aneurysm and determine your treatment plan.