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EVAR (Endovascular Aneurysm Repair) and TEVAR (Thoracic Endovascular Aortic Repair) are catheter-based treatments of aortic aneurysms and dissections. They are minimally invasive alternatives to open surgery.
What are EVAR and TEVAR?#
EVAR (Endovascular Aneurysm Repair)#
EVAR is used to treat abdominal aortic aneurysms (AAA). A stent-graft is placed into the abdominal aortic aneurysm through the groin.
TEVAR (Thoracic Endovascular Aortic Repair)#
TEVAR is used to treat thoracic aortic aneurysms (TAA) and aortic dissections. A stent-graft is placed into the thoracic aorta through the groin.
Common Advantages:
- No open surgery required
- Minimally invasive
- Shorter hospital stay
- Rapid recovery
- Less pain
EVAR vs TEVAR: Key Differences#
| Feature | EVAR | TEVAR |
|---|---|---|
| Treatment Area | Abdominal aorta | Thoracic aorta |
| Indications | AAA (Abdominal Aortic Aneurysm) | TAA, Type B Dissection, Traumatic aortic injury |
| Critical Structures | Renal arteries, iliac arteries | Subclavian artery, spinal cord |
| Complication Risk | Kidney injury, limb ischemia | Paraplegia, stroke risk |
| Stent-Graft Type | Bifurcated (forked) | Straight tubular |
EVAR Indications (Abdominal Aorta)#
Anatomical Criteria#
- Suitable proximal neck (length and angulation)
- Adequate iliac artery diameter
- Suitable access vessel condition (calcification, tortuosity)
Patient Criteria#
- Aneurysm diameter ≥5.5 cm (male)
- Aneurysm diameter ≥5.0 cm (female)
- Rapidly growing aneurysm (>0.5 cm in 6 months)
- Symptomatic aneurysm (pain, tenderness)
TEVAR Indications (Thoracic Aorta)#
Anatomical Criteria#
- Descending thoracic aortic aneurysm
- Suitable proximal and distal landing zones
- Adequate access vessels
Patient Criteria#
- Thoracic aneurysm diameter ≥5.5-6.0 cm
- Complicated Type B aortic dissection
- Penetrating aortic ulcer
- Traumatic aortic injury
- Intramural hematoma
EVAR vs Open Surgery#
| Feature | EVAR/TEVAR | Open Surgery |
|---|---|---|
| Incision | Small (groin) | Large (abdomen/chest) |
| Anesthesia | Local/Regional | General |
| Hospital stay | 2-3 days | 7-10 days |
| Recovery | 2-4 weeks | 6-12 weeks |
| Follow-up | Regular CT | Less frequent |
| Mortality | Lower | Higher |
Pre-EVAR/TEVAR Evaluation#
Imaging#
- CT Angiography (mandatory)
- Aortic anatomy assessment
- Iliac artery evaluation
- Renal arteries (for EVAR)
- Cerebral vessels (for TEVAR)
- Visceral arteries
Patient Preparation#
- Kidney function tests
- Cardiac evaluation
- Anticoagulation adjustment
- Hydration
- Pre-op antibiotics
- Spinal cord protection assessment (TEVAR)
How are EVAR/TEVAR Performed?#
Procedure Steps#
- Anesthesia: Local, regional, or general
- Femoral artery access: One or both groins
- Guidewire advancement: To aorta
- Stent-graft placement: Over aneurysm/dissection
- For EVAR: Bifurcated graft with limb extensions
- For TEVAR: Straight tubular stent-graft
- Balloon dilation: For sealing
- Control angiography: Result evaluation
- Closure: Percutaneous or surgical
Procedure Duration#
Total duration: 1-3 hours
TEVAR-Specific Considerations#
Spinal Cord Protection#
One of the most important complications in TEVAR is paraplegia (paralysis) risk. To reduce this risk:
- Spinal drainage (when necessary)
- Blood pressure control
- Staged stenting approach
Subclavian Artery Management#
Coverage of the left subclavian artery may be necessary. In this case:
- Pre-operative bypass may be performed
- Parallel stent (chimney) technique can be used
EVAR/TEVAR Results#
Success Criteria#
- Aneurysm/dissection exclusion
- No endoleak
- Stent-graft patency
- Organ perfusion preserved
- Aneurysm sac shrinkage
EVAR Complications#
- Endoleak (most common)
- Stent migration
- Limb thrombosis
- Kidney injury
- Access site complications
TEVAR Complications#
- Paraplegia/paraparesis
- Stroke
- Endoleak
- Left arm ischemia
- Retrograde type A dissection
Post-EVAR/TEVAR Follow-up#
Imaging Protocol#
- 1 month: CT Angiography
- 6 months: CT Angiography
- Annual: CT or Ultrasonography
- Regular follow-up is lifelong
Endoleak Types#
| Type | Source | Treatment |
|---|---|---|
| I | Proximal/distal attachment | Urgent intervention |
| II | Side branches | Usually surveillance |
| III | Graft defect | Intervention |
| IV | Graft porosity | Surveillance |
| V | Endotension | Evaluation |
Frequently Asked Questions#
What is the difference between EVAR and TEVAR?
Is EVAR/TEVAR surgery?
How long is recovery after EVAR/TEVAR?
Is EVAR/TEVAR permanent?
Am I suitable for EVAR/TEVAR?
Can I have MRI after EVAR/TEVAR?
Appointment and Contact#
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Related Peripheral Vascular Treatments#
Other peripheral vascular treatments related to EVAR:
- Abdominal Aortic Aneurysm - Aortic aneurysm treatment
- Peripheral Vascular - Peripheral vascular disease
- Cardiac CT - Computed tomography
- Angiography - General angiography procedures
- Echocardiography - Heart ultrasound