Endovascular Aneurysm Repair (EVAR)
Learn about Endovascular Aneurysm Repair (EVAR) in Singapore, a minimally invasive treatment provided by Dr. Manish Taneja from the Supreme Vascular and Interventional Clinic for selected aortic aneurysms. Understand how EVAR works, benefits, risks and recovery.
Endovascular Aneurysm Repair (EVAR) in Singapore
Minimally Invasive Treatment for Selected Aortic Aneurysms
Endovascular aneurysm repair (EVAR) is a minimally invasive procedure used to treat selected aortic aneurysms by placing a specialised stent graft inside the weakened section of the aorta.
An aortic aneurysm occurs when part of the aortic wall becomes weakened and enlarged. As an aneurysm grows, there can be a risk of complications, including rupture. Rather than opening the abdomen or chest to directly replace the affected section of the aorta, EVAR uses a catheter-based approach to place an endograft inside the aorta.
The graft creates a new pathway for blood flow and reduces pressure on the weakened aneurysm wall.
At the Supreme Vascular and Interventional Clinic, treatment decisions are based on detailed imaging, aortic anatomy, the location and characteristics of the aneurysm, and the patient's overall health.
Care is led by Dr. Maish Taneja, a dual-trained neurointerventional and peripheral vascular intervention specialist, providing specialist vascular expertise from the brain to the body and continuity of care under one roof.
Treatment Overview
| Treatment Type | Minimally invasive endovascular procedure |
|---|---|
| Also Known As | EVAR, endovascular aneurysm repair |
| Commonly Used for | Selected abdominal aortic aneurysms |
| Treatment goal | Exclude the aneurysm from direct blood flow and reduce pressure on the weakened aortic wall |
| How it works | Places a stent graft inside the aorta to create a new blood-flow channel |
| Procedure Access | Usually through the arteries in the groin |
| Imaging Guidance | X-ray and contrast imaging during the procedure |
| Anaesthesia | Depends on the procedure and individual circumstances |
| Follow-Up | Long-term imaging surveillance is important after EVAR |
| Performed By | Dr. Manish Taneja, dual-trained neurointerventional and peripheral vascular intervention specialist |
What Is Endovascular Aneurysm Repair?
Endovascular aneurysm repair is a catheter-based treatment for selected aortic aneurysms. The aorta is the body's main artery, carrying blood from the heart to the rest of the body.
When a section of the aortic wall becomes weakened, it can enlarge and form an aneurysm. The most common type treated with EVAR is an abdominal aortic aneurysm (AAA).
During EVAR, a specialised stent graft is delivered through the blood vessels, usually from the groin. The graft is positioned inside the aorta across the aneurysm. Once deployed, the graft provides a new channel for blood flow and reduces direct blood pressure against the weakened aneurysm wall.
The aneurysm itself is not necessarily removed. Instead, it is excluded from the main blood flow.
Over time, the aneurysm sac may shrink or remain excluded from circulation, depending on the individual circumstances.
How Does EVAR Work?
Repairing an Aortic Aneurysm From Inside the Blood Vessel
Detailed CT angiography or other appropriate imaging is first used to assess the aneurysm and determine whether EVAR is technically suitable. Small access points are made, usually in the groin arteries.
A thin catheter and delivery system is carefully inserted through the groin (femoral artery area) then guided through the blood vessels towards the aneurysm. The specialised stent graft is positioned across the weakened section of the aorta.
The graft is deployed and expanded against the healthy sections of the aorta above and below the aneurysm. Blood then flows through the graft rather than directly against the aneurysm wall. The delivery system is removed and the access sites are closed.
Follow-up imaging is required to monitor the graft and aneurysm over time.
When Might EVAR Be Recommended?
EVAR may be considered for selected patients with an aortic aneurysm when the anatomy is suitable for endovascular repair.
Your specialist will consider:
- The location of the aneurysm
- The size of the aneurysm
- Whether the aneurysm is growing
- Whether symptoms are present
- The shape and anatomy of the aorta
- The condition of the blood vessels used for access
- The available landing zones for the stent graft
- Your age and overall health
- Your surgical risk
- Whether open surgical repair may be more appropriate
Not every aortic aneurysm can be treated with standard EVAR.
Detailed imaging is therefore essential before deciding whether an endovascular approach is suitable.
Aortic Aneurysm Treatment: EVAR vs Open Repair
Understanding the Different Approaches
Aortic aneurysms can be treated using different approaches depending on the patient's anatomy and clinical circumstances.
Endovascular Aneurysm Repair
EVAR places a stent graft inside the aorta through catheter-based access.
It avoids the large abdominal incision required for conventional open repair.
Open Surgical Repair
Open repair involves surgically accessing the aorta and replacing the weakened section with a surgical graft.
The appropriate treatment depends on the aneurysm's anatomy, the patient's overall health and the potential benefits and risks of each approach.
For some patients, EVAR may offer a less invasive alternative to open repair. For others, open repair may be more appropriate.
Potential Benefits of EVAR
A Minimally Invasive Alternative for Selected Patients
When anatomically suitable, EVAR may provide several potential advantages.
Minimally Invasive Access
The procedure is performed through vascular access rather than a large abdominal incision.
Avoids Direct Open Access to the Aneurysm
The aneurysm is treated from inside the blood vessel using a stent graft.
Reduced Surgical Trauma
Compared with open repair, EVAR generally involves less extensive surgical access.
Potentially Faster Initial Recovery
Recovery may be shorter than open surgical repair for appropriately selected patients, although individual recovery varies.
Endovascular Treatment
The procedure uses specialised catheters, imaging and a stent graft to treat the aneurysm from within the vascular system.
It is important to remember: EVAR is not automatically the best treatment for every aortic aneurysm. Detailed imaging and specialist assessment are essential to determine whether the aneurysm's anatomy is suitable.
What Are the Potential Risks and Limitations?
Understanding the Risks of EVAR
EVAR is a minimally invasive procedure, but as with any vascular treatment, there are potential risks and considerations. Because EVAR uses a catheter-based approach rather than a large abdominal incision, hospital stays and recovery times are significantly reduced compared to open surgical repair. Possible considerations may include:
- Temporary discomfort or bruising around the access site
- Changes in kidney function, particularly in patients with existing kidney problems
- Changes in blood flow around the stent graft
- The possibility of an endoleak requiring monitoring or further treatment
- Changes in the position or function of the stent graft
- The possibility of requiring additional treatment in the future
Most importantly, EVAR requires ongoing follow-up and imaging to ensure that the stent graft continues to function as intended and that the aneurysm remains appropriately excluded from blood flow.
The specific risks depend on the patient's anatomy, medical history and type of EVAR performed. Your specialist will discuss the potential benefits, risks and alternatives before treatment.
Why Is Follow-Up Important After EVAR?
Long-Term Aortic Surveillance
EVAR does not mean that follow-up can stop once the stent graft has been placed.
Regular imaging is important to assess:
- The position of the stent graft
- Blood flow through the graft
- The size of the aneurysm sac
- Possible endoleaks
- Graft complications
- Changes in the surrounding aorta
Follow-up may involve CT angiography, ultrasound or other appropriate imaging depending on the patient's circumstances. Long-term surveillance is an important part of the EVAR treatment pathway.
Recovery After EVAR
What Can You Expect After Treatment?
The treatment usually takes 1.5 to 3 hours (though more complex repairs can take up to 4 to 6 hours). EVAR requires a hospital stay of 1 to 2 days for monitoring in a recovery ward or step-down unit. Recovery varies according to the patient's health, aneurysm characteristics and complexity of the procedure.
After EVAR, patients may receive advice regarding:
- Activity and exercise
- Groin access-site care
- Medication
- Hydration
- Warning symptoms
- Follow-up imaging
- Long-term vascular monitoring
Some patients may return to normal activities sooner than after open surgical repair, but recovery should always follow the treating specialist's advice. Most patients have a full and functional recovery and return to normal routine activities within 3 to 6 weeks.
Your EVAR Treatment Journey
| Step | Stage | Description |
|---|---|---|
| 1 | Specialist Aortic Assessment | Review your aneurysm history, symptoms, medical conditions and previous imaging. |
| 2 | Detailed Aortic Imaging | Assess the aneurysm anatomy and determine whether EVAR may be technically suitable. |
| 3 | Individualised Treatment Planning | Compare EVAR, open repair and other appropriate management options. |
| 4 | Endovascular Access | Access the blood vessels, usually through the arteries in the groin. |
| 5 | Stent Graft Positioning | Guide the specialised delivery system through the blood vessels to the aneurysm. |
| 6 | Stent Graft Deployment | Deploy the graft across the aneurysm to redirect blood flow through the graft. |
| 7 | Immediate Imaging Assessment | Use imaging to assess graft position and blood flow before completing treatment. |
| 8 | Recovery & Surveillance | Recover with personalised follow-up and long-term imaging surveillance. |
Why Choose the Supreme Vascular and Interventional Clinic for EVAR?
Brain-to-Body Vascular Expertise Under One Roof
Aortic aneurysm treatment requires careful assessment of the entire vascular system, detailed imaging and an understanding of both minimally invasive and surgical treatment options.
At the Supreme Vascular and Interventional Clinic, care is led by Dr. Manish Taneja, a dual-trained neurointerventional and peripheral vascular intervention specialist.
Brain-to-Body Vascular Expertise
Dr. Manish Taneja's expertise spans neurointerventional and peripheral vascular intervention, providing comprehensive understanding of vascular conditions throughout the body.
Minimally Invasive Approach
Where appropriate, EVAR provides a catheter-based alternative to open surgical repair.
Advanced Imaging and Treatment Planning
Detailed vascular imaging is central to determining whether an aneurysm is suitable for endovascular treatment.
Personalised Decision-Making
The decision to treat an aortic aneurysm depends on its size, anatomy, growth, symptoms and the patient's overall health.
Continuum of Care
Aortic aneurysm treatment does not end with the procedure. Ongoing imaging and specialist surveillance are important after EVAR.
Specialist Care Under One Roof
From vascular assessment and imaging through treatment planning, intervention and follow-up, our specialized clinic provides continuity of specialist care under one roof.
Frequently Asked Questions About EVAR
What type of aneurysm does EVAR treat?
EVAR is most commonly associated with selected abdominal aortic aneurysms, although the specific endovascular approach depends on the location and anatomy of the aneurysm.
How does EVAR treat an aortic aneurysm?
A stent graft is placed inside the aorta across the aneurysm, creating a new pathway for blood flow and reducing pressure on the weakened aneurysm wall.
Is EVAR a minimally invasive procedure?
Yes. EVAR uses catheter-based vascular access rather than the large incision required for conventional open aneurysm repair.
Is EVAR suitable for every aortic aneurysm?
No. The anatomy of the aneurysm and surrounding aorta must be suitable for the particular stent graft and endovascular approach.
What imaging is needed before EVAR?
Detailed vascular imaging, commonly CT angiography, is used to assess the aneurysm and determine whether EVAR is technically appropriate.
What is the difference between EVAR and open aneurysm repair?
EVAR places a stent graft inside the aorta through catheter-based access, while open repair involves surgically accessing and replacing the weakened section of the aorta.
Is EVAR safer than open surgery?
The relative benefits and risks depend on the patient's anatomy, health and clinical circumstances. EVAR can be less invasive than open repair for appropriately selected patients, but it also has specific risks and requires long-term surveillance.
How long does EVAR take?
The procedure duration varies according to the aneurysm anatomy, stent graft used and complexity of the repair.
Standard EVAR typically takes 1.5 to 3 hours (though more complex repairs can take up to 4 to 6 hours).
What happens after EVAR?
Patients recover with personalised aftercare and require follow-up imaging to monitor the stent graft and aneurysm over time.
Why is long-term follow-up necessary after EVAR?
Follow-up imaging helps detect complications such as endoleaks, graft movement, graft blockage or changes in the aneurysm sac.
Can an aortic aneurysm still grow after EVAR?
The aneurysm sac can remain enlarged or change after treatment, which is why ongoing imaging surveillance is important.
Specialist Assessment for Aortic Aneurysm in Singapore
An aortic aneurysm requires careful assessment because the appropriate management depends on its size, location, growth, symptoms and anatomy. At the Supreme Vascular and Interventional Clinic, Dr. Manish Taneja provides specialist vascular assessment, advanced imaging review and personalised treatment planning for patients with vascular conditions.
With expertise spanning the brain and body, our specialized clinic provides minimally invasive vascular and endovascular care with a continuum of specialist support under one roof. If you have been diagnosed with an aortic aneurysm or are considering endovascular aneurysm repair, specialist assessment can help determine whether EVAR or another treatment approach is appropriate for your individual circumstances.
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