Endovascular Aneurysm Repair (EVAR)
What is EVAR?
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Why do you need EVAR ?
EVAR is indicated for:
- Abdominal aortic aneurysm (AAA):
- Aneurysm diameter >5.5 cm in men, >5 cm in women, or rapid growth (>0.5 cm/year).
- Symptomatic AAA: Pain, tenderness (impending rupture).
- Prevalence in India: 3–5% of adults over 65 years; higher in men, smokers, and those with hypertension.
- Other indications:
- Iliac artery aneurysms (if combined with AAA; 10–20% of cases).
- High-risk patients unsuitable for open repair (e.g., elderly, comorbidities like CAD, as in your angioplasty query).
- Contraindications:
- Unfavorable anatomy: Short aortic neck (<10 mm), severe angulation, or extensive thrombus in landing zones.
- Active infection (mycotic aneurysm; rare, <1%).
- Associated treatments:
- Pre-op: Statins, antiplatelets (e.g., aspirin) to manage cardiovascular risk.
- Post-op: Lifelong surveillance with imaging to detect endoleaks; aspirin or dual antiplatelet therapy (DAPT) if stents overlap other vessels.
- Timing:
- Performed in adults (average age 65–80 years); elective for asymptomatic AAA; urgent for symptomatic or ruptured AAA (EVAR has 30–50% lower early mortality than open repair in rupture).
The procedure aims to prevent AAA rupture, a life-threatening event (80–90% mortality if untreated), with a high success rate for aneurysm exclusion and faster recovery than open surgery.
Why Do EVAR Costs Vary in Philippines?
EVAR Procedure
- Before Procedure Evaluation:
- Assessment:
- Imaging: CT angiography (CTA) to measure aneurysm size, neck length, angulation, and iliac artery access (gold standard for planning).
- Blood tests: Kidney function (contrast dye risk), blood sugar, clotting profile.
- Cardiac evaluation: ECG, stress test (50% of AAA patients have CAD, as in your prior queries).
- Preparation: Optimize blood pressure, fasting 4–6 hours, antiplatelets started.
- Consent: Risks, including endoleaks, are explained.
- Assessment:
- Procedure Technique:
- Endovascular Aneurysm Repair (EVAR):
- Performed under general or spinal anesthesia with sedation, lasting 2–4 hours.
- Process:
- Access: Bilateral femoral artery access via small incisions (2–3 cm) in groins or percutaneous puncture.
- Catheters inserted; angiogram performed to map aorta and iliac arteries.
- Stent graft (e.g., Endurant, Excluder) delivered via catheter; deployed to span aneurysm, sealing proximal and distal landing zones.
- Graft expands to exclude aneurysm sac; blood flows through graft, not aneurysm.
- Completion angiogram: Confirms no endoleaks (leakage into aneurysm sac) and patency of renal/iliac arteries.
- Closure: Femoral arteries sealed (manual pressure, closure device, or sutures).
- Intraoperative Tools:
- Fluoroscopy: Real-time X-ray guidance for graft placement.
- Stent graft: Modular (main body + iliac limbs); typically 20–36 mm diameter, 10–20 cm length.
- Contrast dye: Visualizes vessels (50–100 mL used).
- Endovascular Aneurysm Repair (EVAR):
- After Procedure:
- Hospital stay: 2–4 days.
- Care: Monitor groin sites for bleeding; early ambulation (day 1) to prevent clots; check renal function (contrast dye).
- Pain management: Mild pain for 1–3 days (groin access); managed with painkillers (e.g., paracetamol).
- Instructions: Avoid heavy lifting for 2–4 weeks; continue aspirin, statins; schedule imaging follow-up.
Recovery After EVAR
- Hospital Stay: 2–4 days.
- Post-Procedure Care:
- Pain: Mild pain for 1–3 days (groin sites); resolves in 1–2 weeks.
- Activity: Avoid strenuous activity for 2–4 weeks; light walking encouraged day 1–2 to prevent clots.
- Access site: Small groin scars (2–3 cm) or none (percutaneous); fade in 3–6 months; bruising common.
- Symptoms: Aneurysm-related pain (if present) resolves; rupture risk reduced immediately.
- Medications: Aspirin lifelong, statins; DAPT if additional stents used (e.g., iliac overlap).
- Follow-Up:
- Visits at 1 month (check recovery), then every 6–12 months (lifelong surveillance).
- Imaging: CTA at 1 month, 6 months, then yearly; 90–95% aneurysm exclusion at 1 year.
Most resume normal activities in 1–2 weeks; full recovery takes 2–4 weeks. Success rate: 95–98% technical success (graft deployment); 90–95% freedom from rupture at 5 years with proper follow-up.
Risks and Complications
- Procedure Risks:
- Bleeding (2–5%): At groin access; may need surgical repair (<1%).
- Contrast-induced nephropathy (1–3%): Kidney injury from dye; higher risk in CKD patients.
- Anesthesia risks (<1%): Reaction to anesthesia; higher in elderly.
- Post-Procedure:
- Endoleak (10–20% at 1 year): Blood flow into aneurysm sac; types I/III (urgent, need repair), type II (often observed).
- Graft migration (1–3%): Stent shifts; may cause endoleak or occlusion; needs re-intervention.
- Limb occlusion (2–5%): Clot in graft limb; may need thrombolysis or surgery (as in your embolectomy query).
- Infection (1%): Graft infection; rare but may need removal (devastating).
- Long-Term:
- Aneurysm growth (5–10%): If endoleak persists; may need open repair.
- Secondary interventions (10–20% at 5 years): To treat endoleaks, migration, or occlusion.
Report fever, severe abdominal/back pain, leg numbness, or swelling promptly.
Frequently Asked Questions (FAQs)
What causes the need for EVAR?
Abdominal aortic aneurysm (AAA) at high risk of rupture (>5.5 cm, symptomatic, or rapid growth).
Can I avoid EVAR?
Yes, if small: Surveillance (ultrasound every 6–12 months for AAA <5 cm); EVAR needed for large or symptomatic aneurysms.
Is EVAR painful?
Mild pain for 1–3 days (groin access); managed with medication; resolves in 1–2 weeks.
How soon can I resume normal activities?
Light activities: 1–2 days; full recovery: 2–4 weeks; avoid strenuous activity for 2–4 weeks.
Is EVAR covered by insurance in India?
Often covered (medical necessity); confirm with your provider; Ayushman Bharat often subsidizes.
Signs of complications?
Fever, severe abdominal/back pain, leg numbness, or swelling.
How long does the stent graft last?
90–95% functional at 5 years; lifelong if no complications; requires lifelong imaging surveillance.
Lifestyle changes post-procedure?
Quit smoking, control BP/cholesterol, take aspirin/statins, exercise moderately, and attend follow-ups.
Conclusion
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Looking for Best Hospitals for EVAR
Note: we are not promoting any hospitals
We do not promote any hospitals. All details are sourced from Google and hospital websites. Please verify independently. Start with your surgery—here’s the list of government, budget, and superspecialty hospitals accredited by the Department of Health (DOH), Philippine Health Insurance Corporation (PhilHealth), and Joint Commission International (JCI)
- click on your city and schedule your surgery now done in good hands.
| City | Minimum Price (₱) | Maximum Price (₱) |
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Angeles City |
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Antipolo |
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Bacolod |
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Bacoor |
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Baguio |
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Butuan |
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Cagayan de Oro |
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Caloocan |
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Cebu City |
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Dasmariñas |
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Davao City |
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General Santos |
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General Trias |
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Iligan |
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Iloilo City |
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Las Piñas |
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Makati |
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Malolos |
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Manila |
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Muntinlupa |
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Parañaque |
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Pasay |
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Pasig |
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Puerto Princesa |
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Quezon City |
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San Fernando |
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San Jose del Monte |
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Taguig |
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Valenzuela |
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Zamboanga City |
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Disclaimer
This information is sourced from open platforms and is for general awareness only. Costs may vary based on individual cases. Please consult a qualified doctor for medical advice and explore options within your budget before deciding on the procedure.