Abdominal aortic aneurysm is treated either with a covered stent-graft inserted through the groin arteries (EVAR), or with open surgery replacing the aneurysmal segment with a synthetic tube. EVAR is less invasive with faster recovery but needs lifelong imaging follow-up; open surgery is bigger but needs less follow-up. The choice depends on the aneurysm's anatomy and the patient's condition.
When an aortic aneurysm reaches a size that raises rupture risk, grows quickly, or causes symptoms, treatment becomes necessary. There are two main options.
Endovascular stent-graft (EVAR)
A fabric-covered stent-graft is introduced through the groin arteries and opened inside the aorta to line it, so blood flows through the graft and no longer presses on the aneurysm wall.
- No abdominal incision; small punctures or cuts in the groin.
- Shorter hospital stay and faster recovery.
- Needs periodic lifelong imaging to confirm the graft stays in place without leaks.
- Some patients need an additional endovascular procedure over the years.
Open surgery
The abdomen is opened and the aneurysmal segment replaced with a synthetic graft sewn into place.
- A major operation with general anaesthesia, longer stay and slower recovery.
- Durable long-term results with less follow-up once recovered.
- Suitable for some anatomies not suited to a stent-graft.
How is the choice made?
- Aneurysm anatomy: the length and angle of the "neck" below the kidney arteries and the size of the pelvic arteries, measured precisely on CT.
- Age and general health: heart, lung and kidney function.
- Ability to attend regular follow-up.
- Patient preference after the pros and cons are explained.
When does an aneurysm not need treatment?
Small aneurysms are monitored with ultrasound or CT at intervals, with blood-pressure control and stopping smoking. Intervention depends on size, growth rate and symptoms.
Frequently asked questions
Is EVAR better than open surgery?
Each has advantages: EVAR is less invasive with faster recovery; open surgery is bigger but needs less follow-up. The choice depends on anatomy and the patient's condition.
Do I need follow-up after EVAR?
Yes, periodic imaging for life to confirm the graft remains stable.
Does every aortic aneurysm need an operation?
No. Small aneurysms are monitored; intervention depends on size, growth and symptoms.
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