Endovascular Aneurysm Repair (EVAR & TEVAR)
In the past decade open surgical procedures have been partly replaced by the widespread introduction of laparoscopic and endoscopic techniques. Similar changes have affected vascular surgery, with the development of percutaneous transluminal angioplasty for peripheral atherosclerotic disease. Until recently, the treatment of abdominal aneurysms had relied solely on surgical exposure of the aneurysm and direct graft replacement. However, the recent advent of endovascular aortic aneurysm repair has offered an alternative to conventional surgical practice. This new technique has been enthusiastically endorsed by vascular surgeons worldwide.
Endovascular aneurysm repair involves the transfemoral or transiliac placement of a endograft within the aneurysm, with the aim of completely excluding the aneurysm sac from the circulation. The endograft is anchored in place by self expanding or balloon expandable stents, which may support all or part of the graft. The advantages of this technique are principally related to the absence of surgical exposure of the aorta and avoidance of aortic cross clamping, which are both obligatory during direct graft replacement.
The less invasive nature of endovascular aneurysm repair therefore has the potential to reduce the mortality and morbidity of conventional aortic procedures and may offer an opportunity to treat patients with severe coexistent pathologies, who are denied conventional aneurysm repair. Unfortunately, endovascular techniques are not applicable to all patients with abdominal aneurysms, as a short length of normal aorta is required below the renal arteries to facilitate effective fixation of the endograft.
Benefits and Complications of Endovascular Surgery
1. The minimally invasive approach used in endovascular aneurysm surgery allows for an easier recovery for the patient.
2. Many patients are able to have the surgery under epidural anesthesia and leave the hospital the very next day.
3. Blood transfusion is no longer needed.
4. Dr. Aybek’s team has excellent short-term and long-term endovascular repair results, including the lowest complication rate and a zero mortality rate.
What are the risks of endovascular aneurysm surgery?
Vascular surgery places a patient at slight risk of bleeding and blood clots. The experience and expertise of NYU’s vascular surgeons render these complications rare.