How the procedure is performed
EVAR is carried out in a sterile environment under X-ray (fluoroscopic) guidance by a team typically including an interventional radiologist and a vascular surgeon. Anaesthesia may be general, regional (spinal or epidural), or local, depending on the patient and the complexity of the case.
Access to the groin arteries is gained either through small surgical incisions or percutaneously (PEVAR), using a needle puncture technique. Vascular sheaths are introduced into the femoral arteries, allowing passage of guidewires, catheters, and the endograft.
Positioning the stent graft
- A diagnostic angiogram is first performed to identify the exact location of the renal arteries. This ensures that the graft is placed below the renal arteries so blood flow to the kidneys is preserved.
- The main body of the graft is positioned first in the abdominal aorta, followed by the limbs, which extend into the iliac arteries.
- This configuration directs blood through the stent graft, relieving pressure on the aneurysm sac.
How EVAR works
The stent graft forms a new channel (artificial lumen) for blood to flow through:
- Protects the aneurysm sac from direct blood pressure
- Allows the aneurysm to thrombose (clot off)
- Often leads to gradual shrinkage of the aneurysm sac over time