Endovascular aneurysm repair (or endovascular aortic repair) (EVAR) is a type of endovascular surgery used to treat pathology of the aorta, most commonly an abdominal aortic aneurysm (AAA). The procedure involves the placement of an expandable stent graft within the aorta to treat aortic disease without operating directly on the aorta.

EVAR has now surpassed open aortic surgery as the most common technique for repair of AAA.

The procedure is carried out in a sterile environment under x-ray guidance. It is usually carried out by a team of interventional radiologist and vascular surgeon. The procedure can be performed under general, regional (spinal or epidural) or even local anaesthesia.

Access to the patient’s groin arteries can be with surgical incisions or percutaneously in the groin on both sides. Tubes called vascular sheaths are introduced into the patient’s femoral arteries, through which guidewires, catheters and the endograft are passed.

Diagnostic angiography images are captured of the aorta to determine the location of the patient’s renal arteries, so the stent graft can be deployed without blocking these. Failure to achieve this will cause renal failure. With most devices, the “main body” of the endograft is placed first, followed by the “limbs” which join the main body and extend to the iliac arteries, effectively protecting the aneurysm sac from blood pressure.

The endograft acts as an artificial lumen for blood to flow through, protecting the surrounding aneurysm sac. This reduces the pressure in the aneurysm, which itself will usually thrombose and shrink in size over time.