The aorta is the largest artery in the body. The abdominal part of the aorta is located below the diaphragm. It carries blood to the abdomen, pelvis, and legs. Sometimes, the walls of the aorta weaken and bulge in one area. This is called an abdominal
(AAA). When the aneurysm reaches a certain size, it may need to be repaired. Endovascular repair of an AAA (EVAR) is done from the inside of the artery. A stent graft is inserted into the area to strengthen it.
Abdominal Aortic Aneurysm
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This procedure is often done to repair AAA when the aneurysm:
Causes physical symptoms, such as abdominal painCauses complications, such as clots that travel into the legsReaches a certain size and position that meets criteria for EVARHas burst—Surgery must be done right away.
EVAR is now the preferred method to treat AAA. EVAR can result in less pain, shorter hospital stay, fewer complications, and faster recovery time compared to open surgery. However, closer follow-up over many years is needed.
Your doctor will review a list of possible complications, which may include:
Adverse reaction to anesthesiaInfectionBruising or bleedingDamage to blood vessels or organs (possibly requiring open surgery)Leaking of blood at the graftHeart attackBlood clots
Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as: SmokingDrinkingChronic disease such as diabetes or obesity
Your risk of complications may also be increased if you have had: A recent or active infectionBleeding or clotting disorders
Your doctor may:
Do a physical exam, blood tests, and imaging testsAsk about your medical history, including allergies, current medications, bleeding disorders, and other concernsHave you meet with an anesthesiologist
Before the procedure:
Do not eat or drink for 8 hours prior to the procedure.
Talk to your doctor about your medications. You may be asked to stop taking some medications up to 1 week before the procedure.
You will lie on your back. Small incisions will be made in both sides of the groin. Thin tubes called catheters will be inserted into the blood vessels and threaded up toward the aneurysm. Contrast dye will be injected through the catheters. A stent graft will be guided to the site. The graft will be placed into the weakened area and extended into both pelvic arteries. X-ray images will be used to guide each step. Once the graft is in place, the catheters will be removed. The incisions will be closed. Sterile bandages will be applied.
You will be taken to the intensive care unit (ICU). If you have a breathing tube, it will be removed. Your vital signs will be closely monitored.
Anesthesia will prevent pain during the procedure. Your doctor will give you medication to manage the pain during the recovery process. There is little discomfort from the groin incisions.
The usual length of stay is 1-2 days. Your doctor may choose to keep you longer if needed.
At the hospital, you will: Gradually move around and increase your activity levelSlowly return to eating solid foods, as tolerated
During your stay, the hospital staff will take steps to reduce your chance of infection such as: Washing their handsWearing gloves or masksKeeping your incisions covered
There are also steps you can take to reduce your chances of infection such as: Washing your hands often and reminding visitors and healthcare providers to do the sameReminding your healthcare providers to wear gloves or masksNot allowing others to touch your incisions
When you return home, do the following to help ensure a smooth recovery:
Your condition needs to be carefully monitored. Be sure to go to all of your appointments.Follow your doctor's instructions.
After you leave the hospital, contact your doctor if any of the following occur:
Redness, swelling, increasing pain, excessive bleeding, or discharge at the incision siteSigns of infection, including fever and chillsNew abdominal painBack painAny change of color or sensation in your legs or feetBurning, pain, or problems when urinatingNausea or vomiting
Abdominal cramps or
Unusual fatigue or
depressionDisorientation or confusionNumbness or tingling in the legsCoughNew, unexplained symptoms
Call for medical help or go to the emergency room right away if you have:
Shortness of breathChest pain
If you think you have an emergency, call for emergency medical services right away.
Abdominal aortic aneurysm (AAA). EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed. Updated January 22, 2016. Accessed March 2, 2016.
Endovascular repair of thoracic aortic aneurysms. Cleveland Clinic website. Available at:
http://my.clevelandclinic.org/heart/disorders/aorta_marfan/endovascularaorticaneurysm.aspx. Updated August 2009. Accessed March 2, 2016.
Fotis T, Mitsos A, Perdikides T, et al. Regional Anesthesia versus general anesthesia in endovascular aneurism repair: the surgical nursing interventions.
British Journal of Anesthetic and Recovery Nursing.
Last reviewed March 2016 by Michael J. Fucci, DO, FACC
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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