Endovascular Repair for Abdominal Aortic Aneurysm

Treatment Overview

Endovascular repair is a procedure to fix an aortic aneurysm in the abdomen. It's called endovascular because a doctor repairs the aneurysm from the inside of the damaged blood vessel (the aorta).

This is not a surgery. This is a minimally invasive procedure. Local or general anesthesia might be used.

The doctor will make one or two cuts (incisions) in the groin area. Small flexible tubes, called catheters, are inserted into arteries in the groin area. The doctor puts dye into the arteries. The dye will make your aorta show up on X-ray pictures during the procedure.

The doctor uses the catheters to move a man-made tube, called a stent graft, through the arteries until it reaches the aorta. The doctor expands the graft inside of the aneurysm. Then the doctor attaches the graft to the blood vessel. When the graft is in place, the doctor will take out the catheters and the wires. He or she will use stitches to close the incisions in the groin area. After the procedure, blood passes through the graft in the aorta without pushing on the aneurysm.

What To Expect

You may spend 1 to 3 days in the hospital. You can expect the cuts (incisions) in your groin to be sore for 1 to 2 weeks.

You may feel more tired than usual for 1 to 2 weeks after the procedure. You may be able to do many of your usual activities after 1 to 2 weeks. But you will probably need up to 4 weeks to fully recover. You may need to take at least 1 to 2 weeks off from work. It depends on the type of work you do and how you feel.

You will need regular tests, such as a CT scan or ultrasound, to check for problems with the graft. You might have the test one or more times in the first year after this procedure. Then you will have at least one test each year for the rest of your life.

Be sure to tell your dentist and doctors that you have the graft in your aorta. This is important because you may need to take antibiotics before certain procedures to prevent an infection.

Why It Is Done

Repairing an aortic aneurysm is typically recommended if the aneurysm is at risk of bursting open (rupturing). Aortic aneurysms that are large, are causing symptoms, or are rapidly getting bigger are considered at risk of rupturing.

Your doctor will work with you to decide which type of repair surgery—open or endovascular—is right for you. Your doctor will check:

  • The shape and location of your aneurysm.
  • Your age and overall health, to make sure that you are healthy enough for a surgery.
  • If you are able and willing to have the yearly tests that are needed after endovascular repair. Testing is done less often after an open repair.

How Well It Works

When an aortic aneurysm is at risk of rupturing, or bursting open, the benefits of repairing the aneurysm can outweigh the risks. Repairing the aneurysm lowers the risk of rupture and can help a person live longer. Repairing a smaller aneurysm, which doesn't have as high a risk of rupture, does not help a person live longer.footnote 1

Risks

An endovascular repair isn't an open surgery. So it doesn't have the risks or complications of a major surgery, and the recovery time is shorter. But there is a higher risk that you will need another procedure or surgery.footnote 2

About 1 or 2 out of 100 people die during surgery or within 30 days after surgery.footnote 1

Complications include bleeding, infection, and problems with the stent graft. A common complication is a leak around the stent graft.

What To Think About

When making a decision about repairing an aortic aneurysm, you and your doctor will consider the benefits compared to the risks. For some people, the endovascular repair procedure isn't possible, but open repair surgery might be an option.

The U.S. Food and Drug Administration (FDA) gave a premarket approval application to stent grafts in 1999. In 2001, the FDA issued a Public Health Notification for two of these devices: the Ancure System (Guidant) and the AneuRx System (Medtronic AVE). Placement problems, which were associated with damaged artery walls, were reported for the Ancure System. Problems such as leaking, slipping out of place, suture breaks, fabric tears, and poor graft placement were reported for the AneuRx system. Because only a small number of people with these devices have had these problems, the devices remain in use. But the Ancure System has not been made since 2003. If you have one of these systems implanted, talk to your doctor.

References

Citations

  1. Lederle FA, et al. (2007). Systematic review: Repair of unruptured abdominal aortic aneurysm. Annals of Internal Medicine, 146(10): 735-41. DOI: 10.7326/0003-4819-146-10-200705150-00007. Accessed December 22, 2016 .
  2. De Bruin JL, et al. (2010). Long-term outcomes of open or endovascular repair or abdominal aortic aneurysm. New England Journal of Medicine, 362(20): 1881–1889.

Other Works Consulted

  • Patel R, et al. (2016). Endovascular versus open repair of abdominal aortic aneurysm in 15-years' follow-up of the UK endovascular aneurysm repair trial 1 (EVAR trial 1): A randomised controlled trial. The Lancet, 388(10058): 2366-2374. DOI: 10.1016/S0140-6736(16)31135-7. Accessed January 25, 2017 .
  • Rooke TW, et al. (2011). 2011 ACCF/AHA Focused update of the guideline for the management of patients with peripheral artery disease (updating the 2005 guideline): A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology, 58(19): 2020–2045.

Credits

Current as ofSeptember 26, 2018

Author: Healthwise Staff
Medical Review: E. Gregory Thompson MD - Internal Medicine
Adam Husney MD - Family Medicine
Jeffrey J. Gilbertson MD - Vascular Surgery