Endovascular treatment of abdominal aortic aneurysms (EVAR)

Minimally invasive treatment to reduce the risk of aortic rupture

The Aortic Aneurysm Unit at Publio Cordón Memorial Hospital specialises in the diagnosis and treatment of abdominal aortic aneurysms using advanced surgical and endovascular techniques.

Among these, endovascular repair (EVAR) is currently one of the most widely used strategies in suitably selected patients. This procedure allows the dilation of the aorta to be treated from within the vessel, reducing the risk of rupture without the need for open surgery in many cases.

Over time, an aneurysm can progressively weaken the artery wall, increasing the risk of rupture – a serious complication that can be life-threatening. The aim is not only to treat the aneurysm, but also to prevent it from becoming a life-threatening condition.

During the procedure, a vascular prosthesis is implanted to create a new internal channel through which blood flows, thereby reducing the pressure on the weakened wall of the aorta.

Unlike open surgery, access is usually gained via the arteries in the groin, avoiding the need to open the abdomen in most cases and allowing for a less invasive approach.

Not all aneurysms require the same approach, nor do all patients benefit from the same technique. The decision to proceed with treatment is made following a specialist assessment that takes into account clinical criteria, the progression of the aneurysm and the anatomical characteristics of the aorta – all of which are essential to ensure secure anchoring of the prosthesis and a long-lasting outcome.

In which cases is this treatment recommended?

Endovascular repair is considered when the aneurysm has characteristics associated with an increased risk of rupture or an unfavourable outcome.

The indication is based on well-established criteria set out in international clinical guidelines, including:

• Aortic diameter exceeding safety thresholds

• Progressive enlargement observed during follow-up

• The onset of symptoms attributable to the aneurysm

• Vascular anatomy suitable for the safe implantation of the stent graft

The timing of intervention is just as important as the technique used. The aim is to act at the right time, before the aneurysm progresses to a higher-risk stage.

What benefits can the treatment offer?

The aim of the treatment is not only to address the dilation of the aorta, but also to prevent its most serious complication before it occurs.

When correctly indicated, endovascular treatment significantly reduces the risk of rupture and allows the aneurysm to be treated in a planned, controlled manner and with a high degree of precision.

Compared with open surgery, the endovascular approach is less invasive for many patients. Access via the groin arteries avoids large abdominal incisions, which can lead to a faster recovery and less post-operative impact.

For many patients, this results in a more predictable treatment experience, with a well-structured process from the initial assessment through to follow-up care.

Which tests can be used to assess the indication?

In this type of procedure, careful planning is key to ensuring a safe and long-lasting outcome.

Before recommending endovascular repair, it is essential to carry out a detailed assessment of the anatomy of the aorta and the aneurysm.

At the Aortic Aneurysm Unit at the Publio Cordón Memorial Hospital, the assessment includes:

• A specialist consultation in vascular surgery, which allows the diagnosis to be reviewed, the progression of the aneurysm to be analysed and the need for treatment to be assessed.

• A CT angiogram, which is the essential test for accurately measuring the dilation of the aorta, assessing its morphology and planning the procedure with precision.

• Vascular Doppler ultrasound, used both for the initial diagnosis and for monitoring the aneurysm’s progression.

This detailed assessment enables us to determine not only whether endovascular repair is feasible, but also whether it offers the best safety guarantees in each individual case.

How endovascular repair is performed

The procedure is carried out in a specialised operating theatre with advanced radiological monitoring, which allows the aorta to be visualised in real time throughout the procedure.

Access is gained via small incisions in the groin area, through which catheters are inserted and guided through the arterial system until they reach the abdominal aorta.

Once the aneurysm has been located, a vascular stent graft is implanted; this consists of a strong synthetic material supported by a flexible metal framework, designed to adapt to the patient’s anatomy.

Upon deployment, the stent graft is secured above and below the aneurysm, creating a new channel through which blood flows and isolating the dilated area from arterial pressure.

Throughout the procedure, the medical team precisely monitors the position of the device using angiography, ensuring that the seal is adequate and that blood flow is maintained correctly.

The procedure usually takes between one and three hours, depending on the anatomical complexity, and is typically carried out under regional or general anaesthesia.

Recovery and follow-up

Following the procedure, the patient remains under observation so that their initial progress can be monitored.

In most cases, recovery is faster than with open surgery, with a shorter hospital stay and a gradual return to normal activities within a relatively short period of time.

The treatment requires regular follow-up using imaging tests, the aim of which is to check that the prosthesis remains correctly positioned, that the aneurysm remains excluded from the circulation, and that the result remains stable over time.

This follow-up is not a secondary consideration, but an essential part of the treatment, as it ensures its safety and durability.

Specialist assessment at the Unit

The decision to proceed with endovascular repair requires a rigorous and personalised assessment.

At the Aortic Aneurysm Unit at the Publio Cordón Memorial Hospital, each case is analysed on an individual basis, taking into account the characteristics of the aneurysm, the vascular anatomy and the patient’s general condition.

For some patients, the best course of action may be to refrain from intervention and opt for monitored follow-up. For others, endovascular treatment allows for intervention at the right time and with the best possible outcomes.

The aim is always the same: to determine the safest and most appropriate strategy for each patient.