Endovascular repair (EVAR) for Abdominal Aortic Aneurysms

So the minimally invasive keyhole approach is an endovascular stent graft. These stent grafts they're fabric tubes with a metal scaffolding around them and they're squashed up into a delivery device and constrained by this delivery device. It's about as thick as a pen and two meters long. What happens is that the physician accesses the arterial system in the groin usually with a small cut or under ultrasound guidance and once the stent graft is in the arterial system it's pushed up under x-ray guidance into its position and then gradually the delivery device is pulled back and the stent graft opens out. It fixes on to the normal aorta above the aneurysm and into both iliac arteries below the aneurysm and the blood flows through the middle of that fabric tube and the aneurysm around the stent graft plots off and then you hope that it shrinks down. It's got big advantages this procedure along with all other minimally invasive keyhole procedures in that it's far less trauma for you as a patient. You can do it under local anaesthetic, patients can go home in 23 hours and they back up on their feet doing what they enjoy going to work much much earlier than the open repair. That early advantage has a significantly reduced rate of mortality or death as well around the time of the operation and that might be a third that of the open operation in terms of mortality. In In the long term, there is a payback, however. And because these stents are not sewn into the aorta, the aorta can continue to dilate or the stent can slip and move. And there can be leakage around the stent or through the stent graft fabric into the aneurysm sac. If that aneurysm sac is under pressure again, it's a risk of rupturing again. And so a proportion of people need to go back for a relining or an extension or a small procedure to try and keep the aneurysm excluded from the circulation. And that means everybody who has a stent graft needs to be monitored for the rest of their life.