This blog is part of the series entitled Surgical Successes. This series will highlight various surgical procedures that are currently being performed at Eskenazi Health. Recently, Dr. Andres Fajardo, a vascular surgeon with Eskenazi Health, and Lindsey Welty, a nurse practitioner at Eskenazi Health , sat down to discuss the EVAR surgical technique performed at Eskenazi Health.

An aneurysm occurs when part of an artery wall weakens, allowing it to balloon out or widen abnormally. Should the aneurysm reach a certain width (5cm), it may need to be surgically repaired. In a majority of cases, Eskenazi Health vascular surgeons utilize a surgical technique called the endovascular aneurysm repair (EVAR). EVAR is a minimally invasive technique that involves inserting a stent graft, through the femoral arteries, and placing it in the proper spot to repair the aneurysm. 

According to Dr. Andres Fajardo and Lindsey Welty, the endovascular technique is used around 80 percent of the time to repair aortic aneurysms. Utilization of this technique versus traditional open repair technique is contingent on the size of the aneurysm and its proximity to an arterial branch and is preferred due to the decreased post-operative complications, lower mortality rate, less pain, shorter hospital stay and recovery time as compared to traditional open repair of an aortic aneurysm.

To start an EVAR technique, Dr. Fajardo obtains access through the femoral arteries, found in the groin, and places sheaths that lead to the aneurysm’s location. Then, using X-ray and contrast die, the surgeon takes an image of the aneurysm so an endograft can be placed in the correct position to repair the aneurysm. Once the endograft and any additional extensions limbs are placed, the surgeon re-images the area with an X-ray to ensure proper placement. The surgeon completes the EVAR procedure by utilizing closure devices to normalize the femoral arteries so the sheaths can be safely removed. 

Once the surgery is completed, Dr. Fajardo and Welty discuss how recovery begins with an overnight stay in the ICU. Also, the patient must lie flat and avoid leg raising/bending at the waist for the first 4-6 hours of recovery. However, once the patient is able to tolerate eating, drinking, walking and has a proper bowel movement, Dr. Fajardo and Welty note the patient is able to go home. The patient will experience minimal pain that can be controlled with acetaminophen or another prescribed pain medication. 

The patient is required to return for a post-operative check-up one month after the surgery, where they will receive a CT scan to confirm the endograft is still in the correct placement. When that is done, Dr. Fajardo and Welty state the patient can be cleared for all normal activities, but the patient will return for  surveillance CT scans at six months post-surgery, and then annually for life to continually confirm the endograft is in the correct placement. 

Diagnosing an aortic aneurysm quickly is important to treating it effectively. Meet with your primary care provider to learn if you are at risk of an aneurysm or to see if an aneurysm is forming. Medicare covers a screening ultrasound if you have a family history of abdominal aortic aneurysm and/or males ages 65-75 and have smoked 100 or more cigarettes. If you or someone you know needs a primary care provider, please visit www.eskenazihealth.edu/request-an-appointment or call 317.880.0000.

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