Endovascular aneurysm repair (EVAR) is a minimally invasive surgery that may be used for aortic aneurysms. It involves placing a stent into the aorta to prevent a life threatening aneurysm rupture.

Your aorta is the main blood vessel that carries blood away from your heart. An aortic aneurysm is a weakened and bulging area in your aorta.

During EVAR, a surgeon makes an incision in one of your blood vessels, often in your groin. They then use a long, thin tube to access your aneurysm and place a stent. A stent can support your artery walls, keep your artery open, and improve blood flow to your heart.

EVAR tends to have a faster recovery than traditional open surgery to repair an aneurysm. It also tends to cause fewer complications and has a shorter surgical time.

EVAR can also be used for cerebral aneurysms, but this article focuses on its use for aortic aneurysms.

Read on to learn more about EVAR, including when it’s recommended, potential benefits, and what to expect during and after the procedure.

EVAR involves a surgeon inserting a stent into your aorta with a long, thin tube to prevent an aortic aneurysm from rupturing. It may also be used as an emergency surgery after a rupture occurs.

Aortic aneurysms are bulging areas in the largest blood vessel in your body, called the aorta. According to autopsy studies, they’re estimated to occur in about 1 in 33 to 1 in 200 people.

Aneurysms that rupture come with a high risk of fatal bleeding. EVAR can prevent a rupture before it occurs. The procedure comprises about three-quarters of abdominal aortic aneurysm repairs.

EVAR treats aortic aneurysms below the level of the blood vessels that supply your kidneys. EVAR performed on the upper part of your aorta is called a thoracic EVAR.

Your doctor may recommend EVAR if:

  • you are not a candidate for open-heart surgery
  • you have a small aneurysm that’s growing quickly
  • you have healthy tissue surrounding your aneurysm
  • your aneurysm is in a good location for EVAR

EVAR is a less invasive procedure than open surgery. Most studies show better short-term survival in people who receive EVAR than people who receive open surgery, but the long-term outcomes up to 15 years later seem to be similar.

Slow-growing or small aortic aneurysms may not need surgical treatment if your doctor doesn’t think you’re at risk of developing a rupture.

Alternative aortic aneurysm treatments

The best aortic aneurysm treatment largely depends on the size of your aneurysm and your risk of rupture. Along with EVAR, other treatments include:

EVAR may be performed under general anesthesia to put you asleep or local anesthesia to numb the area around your incision. Both types of anesthesia aim to minimize discomfort.

During EVAR, your surgeon will:

  1. Make a large incision into one of your blood vessels, usually in your groin.
  2. Insert a small flexible tube into your blood vessel to place a stent made of metal mesh lined with fabric.
  3. Deploy the stent into the right position in your aorta to cover the aneurysm.
  4. Close your wound with stitches or staples and cover it with bandages.

Most people spend at least a few days in the hospital after an EVAR.

In a 2019 study, researchers found that 11.2% of people needed to stay in the hospital for more than a week. People who developed postoperative respiratory failure were at a significantly higher risk of needing to stay longer than a week.

The recovery for EVAR is generally faster than for an open repair. You might feel very tired for several weeks after your procedure. A full recovery can take 3 to 6 weeks.

It’s important to follow your surgeon’s recovery timeline and avoid overexerting yourself until you’re fully healed.

Most surgeons recommend that you avoid lifting heavy objects for about 6 weeks after your procedure. Many people need to take 6 to 12 weeks off work, depending on how physically demanding their job is.

All procedures come with some risk of complications. Potential risks of EVAR include:

Open aneurysm repair is considered a high risk surgery, meaning it comes with a more than 5% risk of cardiovascular death or heart attack within 30 days.

EVAR is an intermediate risk procedure with a risk between 1% and 5%.

EVAR has high rates of success, with some studies reporting technical success in more than 96% of procedures.

Most studies have found better short-term survival after EVAR than open surgery, but research suggests the long-term outcomes might be similar, or EVAR might have a slightly worse outcome.

In a 2022 study, researchers reported a 30-day death rate of 1.2% after EVAR compared with 4.0% after open surgery among more than 30,000 people who received these surgeries.

The risk of death and complications is generally much higher for emergency procedures than for procedures scheduled to prevent a rupture before it occurs.

An EVAR is a minimally invasive type of surgery used to treat an aortic aneurysm. It involves a surgeon making a small incision into a blood vessel, usually in your groin, and using a long, thin tube to place a stent in your aorta.

EVAR has high rates of success and can potentially prevent life threatening bleeding. Your doctor may recommend surgical treatment of an aortic aneurysm if it’s large or has a high risk of getting bigger in the future.