Endovascular Aneurysm Repair (EVAR)

Endovascular Aneurysm Repair is performed in a hybrid operating theatre equipped with high-resolution C-arm imaging. Under regional or general anaesthesia, Dr. Sharma accesses both femoral arteries in the groin — usually through small punctures rather than open cuts. Guidewires and delivery catheters are threaded up to the aorta under continuous X-ray guidance.

A custom-sized, fabric-covered stent-graft is then deployed precisely across the aneurysm, from healthy aorta above the bulge to healthy iliac artery below it. Once expanded, the graft creates a new, sealed channel for blood flow, completely excluding the weakened aneurysm sac from arterial pressure. The procedure typically takes 90–120 minutes.

Because there is no large abdominal incision, blood loss is minimal and the physiological stress on the body is far lower than open aneurysm repair. Most patients are mobile within hours and many avoid the intensive care unit altogether, moving straight to a step-down ward.

Not every aneurysm needs immediate treatment. Small aneurysms under 5 cm are usually monitored with six-monthly ultrasound, since the rupture risk is low and grows sharply only above certain thresholds. Once an aneurysm reaches around 5.5 cm in men or 5.0 cm in women, or grows more than 1 cm in a year, the rupture risk begins to outweigh the risk of repair.

The 'neck' of the aneurysm — the segment of normal aorta just below the kidney arteries — is the single most important anatomical factor in EVAR planning. A short, angulated or heavily calcified neck may need a fenestrated or branched stent-graft rather than a standard device, and Dr. Sharma reviews every CT angiogram personally before recommending a specific graft design.

Iliac artery tortuosity, calcification and diameter also influence whether standard femoral access is possible or whether an iliac conduit is required. This detailed, individualised planning is what separates a durable EVAR from one that fails early.

An endoleak is persistent blood flow into the aneurysm sac outside the stent-graft, and it is the most important complication unique to endovascular repair. Type I leaks (at the graft's attachment points) and Type III leaks (through the graft fabric or joints) need prompt correction, since they keep the sac under pressure. Type II leaks, from small branch vessels like the lumbar or inferior mesenteric arteries, are more common and often resolve on their own but still require monitoring.

This is why EVAR is not a one-time fix-and-forget procedure — it demands structured lifelong imaging. Dr. Sharma's surveillance protocol includes a CT angiogram at one month, a duplex ultrasound at six and twelve months, and yearly duplex scans thereafter (with CT if any abnormality is suspected).

Patients who skip surveillance risk silent sac growth and, rarely, late rupture even after a technically successful EVAR. Renova Century Hospital maintains a dedicated recall system so patients across Telangana and neighbouring states do not lose follow-up continuity.

Open aneurysm repair involves a large abdominal incision, clamping the aorta, and sewing in a synthetic graft directly — an operation that carries higher blood loss, a longer ICU stay and a recovery period of 6–8 weeks. It remains the right choice for patients with unfavourable anatomy for EVAR, or those who need a more durable, one-time repair and can tolerate major surgery.

EVAR, by contrast, offers a markedly lower 30-day mortality and complication rate, particularly valuable in patients over 70 or those with coronary artery disease, COPD or chronic kidney disease who would be high-risk candidates for open surgery. The trade-off is the need for lifelong surveillance and the small but real possibility of needing a secondary intervention years later.

Dr. Sharma's dual training in both open and endovascular aortic surgery means the decision is never a 'one size fits all' — it is based on aneurysm anatomy, overall fitness, patient preference and long-term life expectancy.

Within the first week, most patients are walking normally, managing stairs and eating a regular diet. Heavy lifting and strenuous exercise are avoided for around four weeks to allow the groin access sites to heal fully, after which the vast majority of patients return to their pre-aneurysm lifestyle without restriction.

Blood pressure control, statin therapy, antiplatelet medication and smoking cessation remain essential for life — not because of the stent-graft itself, but because the same atherosclerotic process that caused the aneurysm continues to affect the rest of the cardiovascular system.

Sexual function, travel and even long-haul flights are generally unaffected once initial healing is complete, and patients are encouraged to carry a card noting their stent-graft type and size for any future medical emergency or unrelated surgery.