EVAR

What this procedure is

EVAR stands for endovascular aneurysm repair. It is a way to fix a weak spot in the body’s main artery (the aorta) without needing a large incision in the abdomen. Instead, your clinician uses small cuts in the groin area to reach the blood vessels.

During the procedure, a thin, flexible tube called a catheter is used to guide a device called a stent-graft to the right spot. A stent-graft is a small tube made of fabric and metal mesh. Once it is in place, it expands to fit against the walls of the artery. This creates a new, strong path for blood to flow through, which protects the weak area of the vessel.

What it treats or fixes

This procedure is used to treat an abdominal aortic aneurysm (AAA). An aneurysm is a bulge or "ballooning" in the wall of the aorta, which is the large blood vessel that carries blood from your heart to the rest of your body.

The main goal of EVAR is to keep the aneurysm from getting larger or leaking. By lining the aorta with a stent-graft, the procedure takes the pressure off the weakened wall. This helps ensure that blood continues to flow safely to your legs and organs.

How common it is & where it's done

EVAR is a very common procedure and is often a preferred choice for many patients because it is less invasive than traditional open surgery. Because it uses smaller incisions, it often leads to a shorter stay in the hospital and a faster return to daily activities.

The procedure is performed in a hospital setting. It usually takes place in a specialized operating room or a catheterization laboratory (cath lab) equipped with advanced imaging tools. These tools allow the medical team to see the blood vessels clearly on a screen while they work.

Recovery: What to Expect

Most patients stay in the hospital for 1 to 3 days after an EVAR procedure. You may feel some soreness or see bruising near the groin, where the clinician inserted the small tubes (catheters). This is normal and usually fades within a few days.

Your clinician may encourage you to start walking short distances soon after you get home to help your circulation. However, you should avoid heavy lifting, driving, or intense exercise for about two weeks to allow the small incisions to heal completely.

Risks & Possible Complications

While EVAR is less invasive than open surgery, there are some risks to be aware of. These can include bleeding, infection at the incision site, or a reaction to the contrast dye used during the procedure. Your care team will monitor you closely for these issues while you are in the hospital.

A specific concern with EVAR is an "endoleak." This happens if blood continues to flow into the aneurysm (the bulge in the artery) instead of through the new fabric tube. Most endoleaks do not cause symptoms and are found during routine check-ups. Your clinician may monitor these or suggest a minor touch-up if needed.

When to call your clinician:

• If you notice redness, warmth, or drainage at the incision site.
• If you have a fever or chills.
• If you feel sudden or severe pain in your back or abdomen.
• If your leg feels cold, numb, or changes color.

Outcomes & Long-Term Results

The main goal of EVAR is to strengthen the aorta (the body's main artery) and prevent the aneurysm from growing or bursting. This procedure is very effective, but it requires lifelong follow-up. Because the graft is a medical device, your clinician will want to check it regularly.

You will likely have imaging tests, such as an ultrasound or a CT scan, a few weeks after the procedure and then once a year. These tests make sure the graft is still in the right place and working as it should to protect your health.

Emotional Support & Reassurance

It is normal to feel some anxiety when dealing with a blood vessel condition. Many patients find comfort in knowing that EVAR is a common procedure with a much shorter recovery time than traditional open surgery. Most people return to their usual daily routine and feel like themselves again within a few weeks.

Your medical team is there to help you feel confident. If you have questions about your activity levels or long-term health, do not hesitate to ask. Staying informed and following your check-up schedule can provide great peace of mind as you move forward.

Why doctors recommend it

Doctors usually suggest EVAR to treat an abdominal aortic aneurysm (AAA). This is a weak, bulging area in the aorta, which is the large blood vessel that carries blood from your heart to the rest of your body. If the bulge gets too large, it could potentially leak or burst.

Your clinician may recommend this procedure if the aneurysm has reached a certain size or if it is growing faster than expected. EVAR is often chosen because it is less invasive than traditional "open" surgery. Instead of a large incision in the abdomen, doctors use small cuts in the groin to reach the area. This method is generally easier on the body and may allow for a faster recovery.

Urgent vs planned treatment

Most EVAR procedures are planned in advance. This happens after your care team has monitored the aneurysm with imaging tests like ultrasound or CT scans. When the risk of the aneurysm causing problems becomes higher than the risk of surgery, a planned procedure is scheduled to protect your health.

In some cases, treatment may be urgent. If an aneurysm is causing new pain or shows signs that it might leak, doctors may move quickly to perform the repair. This helps prevent a more serious emergency before it happens.

Emergency EVAR is used if an aneurysm has already started to leak or has ruptured. While this is a very serious situation, the goal is to use the stent-graft to seal the area and stop internal bleeding as quickly as possible.

Goals of treatment

The primary goal of EVAR is to prevent the aneurysm from bursting. A burst aneurysm can cause severe internal bleeding. By reinforcing the artery, the procedure aims to keep the blood vessel stable and safe.

During the procedure, a device called a stent-graft—a fabric tube supported by a metal mesh—is placed inside the aorta. Success means the blood now flows through this sturdy tube instead of pressing against the weakened walls of the aneurysm. Over time, the aneurysm may even shrink around the graft.

Other goals of treatment include:

• Reducing the pressure on the damaged part of the artery.
• Helping you return to your daily routine with more peace of mind.
• Providing a long-term way to manage the aneurysm without the need for major abdominal surgery.

Who may benefit

Endovascular aneurysm repair (EVAR) is a procedure used to treat an abdominal aortic aneurysm (AAA). This is a bulge or weak spot in the aorta, which is the body's main artery that carries blood from the heart to the rest of the body. Your clinician may recommend this procedure if the aneurysm has reached a certain size—often about 2 inches (5 centimeters) or larger—or if it is growing quickly.

This approach is often a good choice for people who want a less invasive option than traditional open surgery. Because it uses small incisions in the groin rather than a large opening in the abdomen, it may lead to a shorter hospital stay and a faster return to daily activities. It is also frequently considered for patients who may have other health conditions that make a larger surgery more difficult for the body to handle.

When it may not be the right option

While EVAR is a common choice, it is not the right fit for everyone. The most important factor is often the shape and location of the aneurysm. To use a stent graft—a fabric-covered tube that reinforces the artery—there must be enough healthy tissue for the device to attach to securely. If the aneurysm is too close to other major blood vessels or if the arteries are too narrow or twisted, your clinician may suggest a different approach.

Additionally, if an aneurysm is small and not causing any symptoms, your care team might recommend "watchful waiting." This involves regular imaging tests to monitor the size of the bulge rather than having surgery right away. Because EVAR requires lifelong follow-up with regular scans to ensure the graft stays in place, patients must be able to commit to these long-term checkups.

Questions to ask your care team

Deciding on the right treatment is a shared process between you and your medical team. Here are some questions you may want to bring to your next appointment:

• Why is EVAR the best choice for me compared to open surgery or monitoring?
• Is the shape of my aneurysm a good fit for the stent graft devices available?
• What are the specific risks and benefits based on my personal health history?
• How often will I need follow-up scans after the procedure is finished?
• What should I expect during the recovery period at home?

In the procedure room

When you arrive for your procedure, you will be helped onto a padded table in a specialized room. This room is equipped with large monitors and X-ray machines that allow the medical team to see your blood vessels in real-time. The team will place small patches on your chest to track your heart rate and a clip on your finger to check your oxygen levels.

High-level steps

The procedure focuses on placing a stent graft (a fabric-covered metal tube) inside your aorta to protect the weak area. Your clinician will follow these general steps:

• Small openings or punctures are made in the groin area to reach the large arteries in your legs.
• A catheter (a long, thin, flexible tube) is inserted into the artery and carefully guided toward the aneurysm using X-ray images.
• The stent graft is moved through the catheter to the site of the aneurysm.
• Once in place, the graft is expanded so it fits tightly against the artery walls. This creates a new, strong channel for blood to flow through, taking the pressure off the aneurysm (the weak, bulging spot in the artery).
• The catheters are removed, and the small openings in the groin are closed with stitches or a special closure device.

Anesthesia and pain control

Your care team will choose the best way to keep you comfortable and pain-free. Your clinician may use general anesthesia, which allows you to sleep through the entire process. In other cases, they may use regional anesthesia to numb the lower half of your body, or local anesthesia combined with medicine to help you feel very relaxed and sleepy. You should not feel pain during the repair.

Monitoring and safety steps

Safety is a priority throughout the procedure. The team constantly monitors your vital signs, including your blood pressure and heart rhythm. They also use a special dye, called contrast, which shows up on X-rays. This helps the doctor confirm that the graft is in the exact right position and that there are no leaks before the procedure is finished.

Immediately after the procedure

After the repair is done, you will be moved to a recovery area. You will typically be asked to lie flat on your back for several hours—usually between 2 and 6 hours. This is a very important step to help the small openings in your groin heal and to prevent any bleeding. Nurses will check your bandages and the pulses in your feet frequently to ensure everything is healing as it should. You may feel some mild soreness or pressure in your groin, but this is common and can be managed with medicine.

Typical procedure length

While every patient is unique, the procedure usually takes about 2 to 3 hours to complete. Your clinician will provide a more specific timeline based on your individual health needs and the complexity of the repair.

Common approaches (open vs minimally invasive)

When treating an abdominal aortic aneurysm, your clinical team will evaluate whether a traditional surgery or a less invasive method is safer for you. The choice often depends on your overall health and the shape of your aorta.

• Open Repair: This is the traditional surgical approach. The doctor makes a large incision (cut) in the abdomen to reach the aorta directly. They sew a graft into place to replace the weakened section of the artery. This method usually requires general anesthesia and a longer recovery time in the hospital.
• Endovascular Aneurysm Repair (EVAR): This is a minimally invasive option. Instead of a large incision, the doctor makes small cuts near the groin. They thread a thin tube called a catheter through the blood vessels to place a stent graft inside the aneurysm. This relines the artery from the inside, often leading to a shorter hospital stay and faster recovery.

Partial vs total

In the context of aneurysm repair, the goal is typically to completely seal off the weak spot in the artery. Unlike some surgeries where only a portion of a damaged area might be removed or fixed, EVAR aims to fully exclude the aneurysm from blood flow. This ensures the pressure of your blood goes through the new graft rather than pushing against the weakened vessel wall.

Because the main safety goal is to prevent the aneurysm from bursting, a "partial" repair is generally not applicable. Your doctor will select a stent graft that fits the specific length and shape of your blood vessels to ensure the entire problem area is covered and protected.

Revision or repeat procedures

While EVAR is less invasive than open surgery, it requires lifelong monitoring to ensure the repair stays secure. Your clinician will likely schedule regular imaging tests, such as CT scans, to check the position of the graft.

Sometimes, the graft may slip, or blood may begin to leak around the edges of the graft (a condition called an endoleak). If this happens, a revision or repeat procedure may be necessary to fix the seal. Research suggests that the need for these follow-up procedures is more common with EVAR than with open repair, though the revisions themselves are often minimally invasive.

Tests and imaging that may be done

Before your procedure, your healthcare team needs to check your overall health and map out the shape of your aneurysm. This helps them choose the right size for the stent graft used during the repair. You may undergo a few standard tests in the days or weeks leading up to your appointment.

Common pre-procedure tests include:

• Blood tests: These check your kidney function and how well your blood clots.
• Electrocardiogram (ECG or EKG): This test records the electrical activity of your heart to check for any rhythm problems.
• Imaging scans: A computed tomography (CT) scan or ultrasound is often used to create detailed pictures of your blood vessels.
• Chest X-ray: This may be done to check the health of your lungs.

Medication adjustments

It is important to tell your clinician about every medicine you take. This includes prescription drugs, over-the-counter medicines, vitamins, and herbal supplements. Some substances can increase the risk of bleeding or interact with the anesthesia used during the procedure.

Your doctor may ask you to pause certain medications, such as blood thinners (anticoagulants) or aspirin, for a short time before the surgery. If you have diabetes, you may need to adjust your insulin or other medications because you will not be eating before the procedure. Only stop or change your medicines if your clinician specifically instructs you to do so.

Day-before and day-of instructions

Your care team will give you a specific plan to follow to ensure you are ready for the procedure. Following these steps carefully helps prevent delays or complications.

The day before:

• Fasting: You will likely be told not to eat or drink anything after midnight. This includes water, gum, and mints.
• Packing: Pack a bag with your photo ID, insurance card, and loose, comfortable clothing for when you go home.
• Hygiene: You might be asked to shower with a special antibacterial soap to reduce the risk of infection.

The day of the procedure:

• Medications: If your doctor told you to take specific pills on the morning of the procedure, take them with only a small sip of water.
• Allergies: Remind the medical staff if you have any allergies, especially to contrast dye, iodine, latex, or shellfish.
• Personal items: Leave jewelry, watches, and other valuables at home. You may need to remove contact lenses, dentures, or hearing aids before the procedure begins.

General surgical risks

As with any medical procedure, endovascular aneurysm repair (EVAR) carries some general risks. Because the procedure is less invasive than open surgery, these risks are often lower, but they are still possible. Your care team will take steps to prevent infection at the small incision sites in the groin. They will also monitor you closely for any signs of bleeding.

There is also a chance of having a reaction to the anesthesia (the medicine used to keep you comfortable or asleep). Additionally, any surgery can place temporary stress on the heart or lungs. Your clinician will evaluate your overall health before the procedure to understand and manage these risks.

Procedure-specific complications

EVAR involves placing a fabric and metal tube, called a stent graft, inside the aorta. Sometimes, specific issues related to the device or the procedure can occur. These may include:

• Endoleaks: This happens when blood leaks around the stent graft and continues to flow into the aneurysm. This is the most common issue and is why long-term follow-up is important.
• Device movement: Over time, the stent graft can shift out of its original position (migration), which may affect how well it seals off the aneurysm.
• Kidney stress: The contrast dye used during the imaging part of the procedure can sometimes affect kidney function.
• Blood vessel damage: Rarely, the delivery tools used to guide the graft through the arteries can injure the blood vessel walls or block blood flow to the legs.

How complications are treated

The goal of EVAR is to prevent the aneurysm from growing or bursting. To ensure the device is working correctly, you will need lifelong monitoring. This usually involves regular imaging scans, such as CT scans or ultrasounds, to check for leaks or movement.

If a complication like a small leak is found, it often does not require immediate surgery. Your clinician may simply watch it closely to see if it resolves on its own. If a leak persists or the aneurysm grows, a second, smaller procedure may be needed to seal the leak or secure the graft. In rare cases where the stent graft does not work as planned, a conversion to open surgery might be necessary to repair the aorta.

Pain control medicines

After your EVAR procedure, it is common to feel some mild soreness or discomfort, especially near the small incisions in the groin area. Your clinician may suggest over-the-counter pain relievers, such as acetaminophen, to help you stay comfortable as you heal. In some cases, they may provide a prescription for stronger pain medicine to use for a short time at home.

Your care team will tailor your pain management plan based on your health history. It is important to let your clinician know about any allergies you have to pain medications. Always follow the specific instructions provided by your medical team regarding how and when to take these medicines.

Antibiotics

Antibiotics are medicines used to prevent or treat infections. Because EVAR involves placing a stent-graft (a fabric-covered metal tube) inside your artery, your clinician may give you antibiotics to lower the risk of an infection starting around the new device. These are often given through an IV just before the procedure begins.

Depending on your needs, your doctor might also prescribe a short course of antibiotic pills for you to take after you leave the hospital. To keep the medicine working correctly, it is important to take it exactly as directed. Be sure to tell your care team if you have ever had a reaction or allergy to an antibiotic in the past.

Blood thinners and clot prevention

Blood thinners help prevent blood clots from forming on or around the new stent-graft. Your clinician may ask you to take a daily low-dose aspirin or another type of antiplatelet medicine. These medicines help keep your blood flowing smoothly through the repaired area.

If you were already taking stronger blood thinners for other health reasons, your clinician will give you specific instructions on when to stop and restart them before and after your surgery. Because these medicines can interact with other drugs or supplements, your clinician will review your full list of medications to ensure your plan is safe. Do not stop or change your blood thinner schedule without talking to your medical team first.

Emergency warning signs

Although serious complications are rare, it is important to act quickly if you notice signs of a major problem, such as a blockage in blood flow or a sudden issue with the aneurysm. Call 911 or go to the nearest emergency room if you experience:

• Sudden, severe pain in your back or abdomen.
• Chest pain, shortness of breath, or difficulty breathing.
• Legs that suddenly become cold, pale, or blue.
• Fainting or extreme dizziness.

Call your surgeon or clinic if…

Your healthcare team will likely give you specific instructions on when to contact them during your recovery. Generally, you should reach out if you notice signs of infection or changes in your legs, such as:

• Fever (often defined as over 100.4°F or 38°C) or chills.
• Redness, swelling, or fluid draining from the incision sites in your groin.
• Bleeding at the incision that does not stop.
• Numbness, tingling, weakness, or pain in your legs or feet.
• Nausea or vomiting that does not go away.

Expected vs concerning symptoms

Recovering from EVAR is usually faster than open surgery, but your body still needs time to heal. It is normal to feel tired or have less energy for a few weeks. You may also have mild soreness or bruising around the small cuts in your groin where the device was inserted.

Concerning symptoms include pain that gets worse instead of better, or a lump near your incision that seems to be growing or pulsating. Additionally, some issues with the stent graft, such as a leak (endoleak), may not cause any physical symptoms at all. Because of this, it is vital to keep all follow-up appointments for imaging scans to ensure the repair remains secure.

Non-surgical treatments

If an abdominal aortic aneurysm (a bulge in the main artery of the body) is small, your clinician may suggest managing it without surgery. The primary goal is to keep the aneurysm from growing larger by focusing on heart health and lifestyle changes. These steps help reduce the pressure on the walls of the aorta.

• Blood pressure control: Keeping your blood pressure in a healthy range reduces the constant stress on the weakened area of the artery.
• Smoking cessation: Quitting smoking is one of the most important steps you can take, as tobacco use is strongly linked to the growth of aneurysms.
• Cholesterol management: Your clinician may prescribe medications to help keep your blood vessels as healthy as possible.

Watchful waiting

Watchful waiting, also called active surveillance, is often the first step for aneurysms that are not yet large enough to require a procedure. During this time, your medical team monitors the size of the bulge using regular imaging tests, such as ultrasounds or CT scans (specialized pictures of the inside of the body).

These check-ups usually happen every 6 to 12 months. This approach allows you to avoid the risks of surgery as long as the aneurysm remains stable and small. Your clinician will compare each new scan to previous ones to see if any significant changes have occurred over time.

When surgery becomes the best option

Your clinician may recommend EVAR or another type of repair if the aneurysm reaches a certain size, typically around 2 inches (5 centimeters) or larger. At this point, the risk of the aneurysm leaking or bursting may become greater than the risks associated with the surgery itself.

Surgery might also be considered the best option if the aneurysm is growing quickly—for example, increasing in size by more than half a centimeter in six months. If you begin to feel symptoms like persistent pain in your abdomen or back, your care team may decide that a repair is the safest next step to protect your health and prevent a medical emergency.

Hospital services that commonly perform this surgery

EVAR is a specialized procedure that is typically performed in hospitals with dedicated vascular centers. These centers bring together experts from different departments to ensure the best care for your aorta, which is the body's main artery.

• Vascular Surgery: This department focuses on treating conditions of the blood vessels.
• Interventional Radiology: These specialists use advanced imaging, like X-rays, to guide tools through the blood vessels without large incisions.
• Hybrid Operating Suites: Many hospitals use special rooms that combine a traditional operating room with high-tech imaging equipment.

Your care team may also include anesthesiologists, who manage your comfort and safety during the procedure, and specialized nurses who focus on heart and vascular recovery.

Patient resources and support services

Most hospitals provide resources to help you prepare for surgery and manage your health afterward. These services are designed to make your recovery as smooth as possible and help you stay healthy long-term.

• Pre-surgery Education: Many centers offer classes or printed guides to help you understand what to expect before, during, and after your EVAR.
• Imaging and Follow-up: Because the stent-graft (the tube used to repair the vessel) needs to be checked regularly, hospitals provide scheduled CT scans or ultrasounds to ensure the repair remains stable.
• Smoking Cessation Programs: Since smoking can affect your vascular health, many hospitals offer programs to help patients quit.
• Discharge Planning: Social workers or case managers can help arrange for home health care or physical therapy if your clinician recommends it.

Questions for choosing where to have surgery

Choosing where to have your EVAR is an important decision. You may want to ask your clinician or the hospital staff the following questions to feel more confident in your care plan:

• How many EVAR procedures does this hospital and surgical team perform each year?
• Does the team include both vascular surgeons and imaging specialists?
• What is the hospital’s process for long-term follow-up and monitoring of the stent-graft?
• Is there a dedicated vascular recovery area or intensive care unit if needed?
• What resources are available if I have questions or concerns after I am discharged?

Conditions commonly treated by this procedure

The most common condition treated with EVAR is an abdominal aortic aneurysm (AAA). This is a weak, bulging area in the lower part of the aorta, which is the main artery that carries blood from your heart to the rest of your body. Your clinician may recommend this procedure to strengthen the artery wall and help prevent the bulge from leaking or growing larger.

While EVAR is most often used for aneurysms in the belly, similar endovascular techniques may be used for other blood vessel issues. These can include a thoracic aortic aneurysm (a bulge in the chest area) or an aortic dissection, which is a small tear in the inner layer of the artery wall. Your healthcare team will decide if this minimally invasive approach is the right choice for your specific health needs.

Related symptoms people search for

Many people with an aortic aneurysm do not have any noticeable symptoms. Because of this, the condition is often found during a routine physical exam or an imaging test for a different health concern. However, as a bulge grows, some individuals may notice certain signs that lead them to talk with a doctor.

Symptoms that can be associated with an aneurysm may include:

• A pulsing sensation in the abdomen, often described as feeling like a heartbeat near the belly button.
• Persistent or deep pain in the belly or on the side of the abdomen.
• Dull, aching pain in the lower back.

It is important to remember that these symptoms can also be caused by other common health issues. If you experience any of these signs, your clinician may perform an evaluation to determine the cause and ensure you receive the appropriate care.

Evidence overview

Medical researchers and doctors have studied Endovascular Aneurysm Repair (EVAR) extensively to understand how it compares to traditional open surgery. Large studies published in major medical journals have shown that EVAR is generally less invasive. Because it uses small cuts instead of a large incision, patients often experience less pain, spend less time in the hospital, and recover faster.

While EVAR often has fewer risks immediately after the procedure, long-term studies suggest that survival rates over many years are similar to those of open surgery. The main difference is maintenance. Evidence shows that patients who undergo EVAR require regular follow-up imaging to ensure the stent graft remains in the correct position and is working properly. Sometimes, additional minor procedures are needed later to fix leaks or adjust the graft.

Safety notes and individualized care

EVAR is a well-established procedure, but it is not the right choice for every patient. Your safety depends heavily on your specific anatomy. Clinicians use detailed imaging, such as CT scans, to measure the size and shape of your aorta. If the aneurysm is too close to important arteries or if the blood vessels are too twisted, your care team may recommend open surgery as a safer, more durable option.

Like all medical procedures, EVAR carries some risks. Although rare, complications can include:

• Endoleak: This happens if blood leaks around the graft back into the aneurysm sac.
• Graft migration: The stent graft may move from its original spot over time.
• Infection or bleeding: These are standard risks associated with accessing the blood vessels.

Your healthcare provider will weigh these risks against the benefits of a less invasive approach to create a care plan that fits your personal health needs.

Sources used

The information provided here is based on current medical knowledge from reputable sources, including:

• Academic medical centers and university health systems.
• Peer-reviewed medical journals comparing surgical outcomes.
• Standard guidelines for vascular surgery and patient care.