The word endovascular means 'inside a blood vessel.' In an endovascular AAA repair doctors place a strong, flexible tube called an endograft inside the aorta (blood vessel). Instead of making a large incision on the abdomen, doctors make two small incisions near each hip. The doctors then slide the endograft through the femoral arteries (leg blood vessels) and into the aorta. When the endograft is in proper position it expands and seals off the aneurysm so that it is no longer at risk for breaking open and bleeding.
Before an endovascular AAA repair is scheduled, the doctor uses special x-rays (CT scans and angiograms) to measure the exact size of the blood vessels above and below the aneurysm. Based on these measurements, the doctor chooses an endograft that will fit the size of the blood vessels. To place the endograft, the doctor makes two small cuts near each hip (near the crease between the abdomen and the thigh) to get to the femoral arteries (blood vessels). Through these small cuts each part of the endograft is placed into the patient's blood stream. X-rays during the procedure help the doctor guide the endograft into proper position. The endograft then expands to become a strong, flexible tube on the inside of the aorta that seals off the aneurysm and reinforces the blood vessels (aorta and iliac arteries). Before completing the surgery the doctor uses an x-ray to confirm that blood goes through the endograft and does not leak into the aneurysm.
Because it uses small cuts, endovascular AAA repair may cause less discomfort after surgery. Many patients have a short hospital stay of only a few days and they can usually return to normal activity within four to six weeks after surgery.
It is possible for problems with the endograft repair to occur without causing any noticeable symptoms. The doctor can check for these problems by getting pictures (CT scans, ultrasounds) of the endograft at regularly scheduled intervals. If a problem is detected it may need treatment with another procedure. Recommended follow-up includes a check up and CT or ultrasound scan at one month, six months, 12 months and every year thereafter.
No. In order to work properly, an endograft must fit into and completely seal off the aneurysm. If the blood vessel is too large or has too many twists and turns, the endograft will not fit or seal off the aneurysm and the AAA will not be repaired. Doctors are nearly always able to decide which patients can and cannot have an endovascular repair by looking at the patient's x-rays (CT scans and angiograms).