What are EVAR and TEVAR Methods? Treatment of Aortic Aneurysms

What is EVAR?

EVAR (Endovascular Aortic Aneurysm Repair) is one of the minimally invasive surgical methods used to treat abdominal aortic aneurysms in the abdominal region. In this method, the progression of the aneurysm is stopped by placing a special stent graft in the area where the aneurysm is located.

In EVAR, since the procedure is performed directly on the aneurysm, the aorta itself is preserved and the risk of the aneurysm expanding and rupturing is greatly reduced. As it is a minimally invasive procedure, it can be performed in a short time. However, the EVAR method is not suitable for every patient; the patient's vascular structure must be suitable for this method. For this reason, a detailed evaluation is performed before the procedure.

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What is TEVAR?

TEVAR (Thoracic Endovascular Aortic Repair) is a minimally invasive endovascular surgical technique used to treat aneurysms that develop in the thoracic aorta, located in the chest region. It shares a similar system with EVAR but is specifically used to treat aortic vessel problems in the chest region rather than the abdominal region.

The TEVAR procedure is performed by accessing the artery in the groin area without the need to open the chest cavity. A vascular prosthesis called a stent graft is placed here, effectively bypassing the weakened vessel. This prevents the risk of the vessel rupturing.

In Which Cases Is EVAR Applied?

EVAR is a method generally used to treat aneurysms that occur in the abdominal region (abdominal aorta). Aortic aneurysms usually progress without symptoms, but they can have serious consequences if they rupture. The risk of rupture increases, especially as the diameter of the abdominal aortic aneurysm increases. EVAR is performed to eliminate this risk.

EVAR can be applied in the following cases:

• In patients diagnosed with an abdominal aortic aneurysm
• In patients at high risk for open surgery
• If the anatomical structure of the aorta is suitable for EVAR
• In patients with aortic aneurysms and heart, lung, and kidney diseases

EVAR is an alternative method to open surgery. However, it is not a standard method applied to every patient. The decision to perform the procedure is made after a detailed assessment of the patient's general health, the location, size, and shape of the aneurysm.

In Which Cases Is TEVAR Applied?

TEVAR is a method commonly used to treat aneurysms that occur in the thoracic aorta. TEVAR is an important alternative for patients who are at risk for open surgery and require urgent intervention.

TEVAR can be applied in the following cases:

• In patients diagnosed with a thoracic aortic aneurysm
• In patients diagnosed with aortic dissection
• In traumatic aortic injuries
• In structural vascular problems
• In patients at high risk for open surgery

How is the EVAR Procedure Performed?

Before the EVAR procedure, the patient is thoroughly evaluated and the vascular structure is analyzed using CT angiography. It is usually performed by entering through the large arteries called the femoral arteries in the groin area. A guide wire and catheter are placed through these vessels.

The stent graft, also known as a covered vascular prosthesis, is delivered into the vessel through this catheter. This catheter is advanced to the aorta where the aneurysm is located. Once in the appropriate position, the stent graft is opened and fized to the vessel wall. Thus, blood flows through the placed stent rather than the weakened area. After the procedure is completed, the catheters and guide wires are removed, and the vessel access sites are closed. It is usually a procedure that takes 1-2 hours.

Since it is performed without a large incision, the patient's recovery time is short. At the same time, the risk of blood loss and infection is lower. Most patients are discharged within a few days.

How is the TEVAR Procedure Performed?

Before the TEVAR procedure, just like in EVAR, the structure, location, and size of the thoracic aorta are analyzed using CT angiography. The procedure is usually performed under general anesthesia. The procedure sequence is the same as EVAR, only the vessels are different.

The surgeon usually accesses the main arteries by making small incisions in the groin area (femoral artery). With the help of a guide wire and catheter placed here, the problematic aortic region is advanced. After being placed in the correct position, the stent graft is slowly opened and fixed to the vessel wall from the inside. Thus, blood passing through the vessel begins to flow through the stent without coming into contact with the weak area.

The TEVAR procedure is performed closed, without opening the chest cavity. This shortens the surgery time and recovery period. It is a life-saving procedure for critically ill patients who cannot tolerate open surgery.

What is the Difference Between EVAR and TEVAR?

EVAR and TEVAR are both minimally invasive procedures used to treat conditions such as aneurysms and trauma in the aorta. However, EVAR is used to treat abdominal aortic aneurysms located in the abdominal region. TEVAR, on the other hand, is used to treat thoracic aortic diseases located in the chest region (especially conditions such as aneurysms, dissections (aortic rupture), and traumatic vascular injuries).

While EVAR is more concerned with aneurysms, TEVAR is used to treat more sudden and dangerous conditions such as dissections and trauma. The common goal of both methods is to eliminate the risk of rupture and bleeding.

Frequently Asked Questions About the EVAR and TEVAR Methods

Is Aortic Aneurysm Surgery Difficult?

Open surgical methods are generally more difficult and risky. However, closed methods such as EVAR and TEVAR offer a shorter and more comfortable recovery process.

How Long Does Aortic Aneurysm Surgery Take?

Aortic aneurysm surgeries performed with open surgery generally take between 3 and 6 hours. The EVAR procedure, on the other hand, can usually be completed within 1-2 hours because it is performed using a closed method.

What Complications Can Occur After Aortic Aneurysm Surgery?

Complications such as bleeding, infection, embolism (blood clot), and impaired kidney function can occur.

How Many Days Does it Take to Recover After Aneurysm Surgery?

Patients who undergo surgery with the EVAR method are usually discharged within 2-3 days and can return to their daily lives within a few weeks.

What Does EVAR Stand For?

EVAR stands for "Endovascular Aortic Aneurysm Repair".

When is an Aneurysm Dangerous?

Aortic aneurysms generally have an increased risk of rupture when they grow larger than 5 cm or begin to expand rapidly. When a rupture occurs, it is life-threatening.

Does an Aneurysm Go Away on Its Own?

No. An aortic aneurysm does not shrink over time or heal on its own. On the contrary, it can grow over time and the risk of rupture increases.

How Long Does EVAR Surgery Take?

The EVAR procedure usually takes between 1 and 2 hours.