TEVAR/EVAR for an Aortic Aneurysm
A minimally invasive treatment for weakening of a large blood vessel
What is an aortic aneurysm?
The aorta is a large blood vessel that starts in the chest and goes to the belly. It carries blood from the heart to the rest of the body. An aortic aneurysm is a weakening in the wall of the aorta so that it stretches out like a balloon. Things like smoking, high blood pressure, and high cholesterol can weaken the walls of the aorta so that it balloons out over time.
The weakened walls can get so thin that they burst. If an aortic aneurysm bursts, there is a 95 in 100 chance of death. This risk of bursting goes up when the aneurysm is large or grows quickly. Aortic aneurysms are watched carefully so they can be treated before they burst.
TEVAR/EVAR is a minimally invasive, image-guided treatment for aortic aneurysms that can be an alternative to surgery. It is called a TEVAR when it is done to fix an aortic aneurysm in the chest. It is called an EVAR when it is done to fix an aortic aneurysm in the belly.
How is TEVAR/EVAR done?
You will be given medicines to put you to sleep. The clinician numbs the skin on both upper thighs. They thread small plastic tubes through the skin into the arteries. They use moving x-rays to guide the tubes to the aortic aneurysm. They put a mesh metal tube called a stent graft across the aneurysm to let blood flow past it. This is done to block off the aneurysm so it cannot fill with blood. If there are blood vessels going to the aneurysm, they may block them off with soft coils or other materials so they cannot fill the aneurysm with blood. After, they close the holes in the arteries and put bandages over the skin on both sides. If the clinician has to make a small cut over the artery at the thigh, they will close this cut with stitches.
TEVAR/EVAR Procedure
1. After numbing the skin, the clinician threads a small tube through the artery at the top of the thigh and to the aortic aneurysm.
2. They put a stent graft across the aneurysm so blood will flow past it.
3. After, they remove the tube and close the hole in the artery and place a bandage over the skin.
What are the risks?
TEVAR/EVAR is generally a safe procedure when done by a specialist.
1 in 20 people develop an endoleak which happens when a tiny bit of blood can still flow through the aneurysm. This is called an endoleak. Some endoleaks can be watched without treatment. Others have to be fixed with another procedure to plug up the blood vessels or reinforce the stent graft.
3-5 in 100 people experience a stroke.
2-3 in 100 people
have decreased blood flow to the spinal cord causing paralysis
have damage to the blood vessels
experience bleeding
develop infection
have temporary fever
experience back pain
What are the alternatives?
Your options will depend upon your specific health condition and your preferences.
Alternative 1 Not treating the aortic aneurysm. The advantage of this is avoiding a procedure. The disadvantage is that it could burst and cause life-threatening bleeding.
Alternative 2 Surgery to repair the aorta. This option can be more successful on the first try. However, it requires a longer recovery and has higher risks of complications.