Having an EVAR

Pre-assessment

You may be asked to attend a pre-assessment appointment before your surgery. A doctor or nurse will assess your fitness to have the surgery.

Some people are seen by the proactive care of the older person undergoing surgery (POPS) team, who will do medical and social checks.

Medicines

Your regular medicines will be checked.

You will be given advice on which ones you might need to stop taking for a short time before your procedure. This might include antiplatelet medicines (such as aspirin, or clopidogrel) or medicines that thin the blood (such as warfarin).

If you are taking any medicines for diabetes (for example, metformin) or using insulin, the dose may need to be altered or temporarily stopped near the time of the procedure. 

Please let us know if you are taking any regular medicines, including any herbal or homeopathic medicines you buy in a shop or pharmacy.

Also let us know if you have any allergies to any medicines.

You will be given full information on any changes that you need to make to your medicines at the pre-assessment appointment. Please ask us if you have any questions. 

Stopping food and drink before surgery (fasting)

We will give you information about fasting, which is usually for 6 hours before surgery. Fasting means that you cannot eat or drink anything (except water). We will give you clear instructions on whether you need to fast and when to start fasting. It is important to follow these instructions. If there is food or liquid in your stomach during the operation, it could come up to the back of your throat and damage your lungs. 

You can take your regular morning medicines with a sip of water before 6am on the morning of the procedure, unless you have been told otherwise.

Having an EVAR

You will be admitted to a ward the night before, or on the morning, of your EVAR. On the day, you will be taken to either the X-ray (radiology) department or the theatre. You will be checked in by your team, and can ask any questions you have. 

The procedure is done by a vascular surgeon (who is an expert in blood vessels), and a radiologist (a doctor who uses scans to help during surgery). It uses X-rays to guide medical instruments inside your arteries. 

An EVAR can be done under general anaesthetic, regional anaesthetic or local anaesthetic so that you should not feel any pain. An anaesthetist will talk to you about the type of anaesthetic you will have, and what will happen before the procedure. 

You can read our information about having an anaesthetic.

The procedure usually takes 2 hours, but it can take longer depending on the type of EVAR you are having.

In the procedure room you will be asked to lie on your back on an X-ray table.

• A small plastic tube (cannula) will be put into your arm. We can give you medicines through the cannula if you need them during the procedure. 
• Equipment will be attached to you to measure your blood pressure and heart rate. 
• We will clean your groin with an antiseptic fluid, and place a cloth over most of your body. 
• You will have a flexible tube (catheter) put in to your bladder. 
• If you are having a FEVAR or BEVAR, you might need a cerebrospinal fluid (CSF) drain put in before or after your procedure. This drains fluid from your spine.
• A small cut will be made in the artery in your groin. If you are having a BEVAR, you might also have a small cut in your upper left arm.  
• A short tube (called a sheath) will be put into the artery to keep it open. Then, a thin, flexible tube (catheter) is put in to the artery and towards the aneurysm. 
• Contrast dye is injected into the catheter. This shows up on the X-ray monitor to guide the radiologist to the aneurysm.
• The endograft is passed through the catheter and put in to the aneurysm. 
• When the graft is in position, it is opened. This creates new walls in the artery which blood can flow through. When the stent is opened it seals the aneurysm.
• The catheter will be removed. The hole in your artery will be closed using a closure device, or stitch. You will have a waterproof dressing put your groin. 

After having an EVAR

If you have had a standard EVAR, you will wake up in the recovery room. You will be closely monitored until you are well enough to be taken back to a ward.

Once on the ward, we will continue to monitor your recovery.

• You can eat and drink as normal.
• When you are able to, you will be asked to sit up or move around the ward.
• You will stay on the ward overnight.

The next day, you will have some blood tests and be checked by your team. If you can move around safety and your test results are fine, you should be allowed to go home.

If you have had a FEVAR or BEVAR, you will need more monitoring in the overnight intensive recovery (OIR) ward, or a high dependency unit (HDU). You will be taken back to a ward when you are well enough, and be allowed to go home when can move around safety and your test results are fine. You can expect to be in hospital for about 2 days after your procedure.

Pain

It is quite normal to feel some discomfort from the wounds, but this will get better over the first few days after your procedure. Your nurse can give you painkillers if you need them.

Leaving hospital

Your dressing will be removed before you leave hospital. If you need a dressing when you go home, you might be given some to change yourself. Or, your GP's practice nurse can change it for you.

If your stitches need removing, your GP's practice nurse will remove them for you. They will also check your wound. Your hospital team will give you a letter to take to the GP surgery 2 days after you leave hospital to arrange this. If you are not able to travel to your GP, your hospital team will refer you to a district nurse who can visit you at home. 

You wounds should be dry before you leave hospital. Once they are dry you can have a shower. We advise to wait 2 weeks before having a bath due to the dissolvable stitches.

Recovery after an EVAR

You might feel very tired (fatigue) and weak for many weeks after an EVAR.

You might have less of an appetite and lack of taste. This will get better as time goes by. 

Full recovery after an EVAR can take 3 to 6 weeks. This time is different for everyone and depends on your age and general fitness. 

Returning to normal activities

You can carry out your normal day-to-day activities immediately after your treatment. However, you should avoid strenuous exercise for the first few days and then gradually build up the amount you do. Do not exert yourself initially, and be guided by how well you feel.

Exercise

A short walk, along with rest, is recommended for the first few weeks. After this time, you can slowly return to your normal activity. You should not lift heavy objects for 6 weeks after surgery.

Driving

We advise that you do not drive for at least 48 hours after your procedure. You should only drive again when you are free of pain and able to perform an emergency stop comfortably. You should check with your insurance company to make sure you are covered to start driving again. If you are taking painkillers, please check with a pharmacist whether it is safe for you to drive.

Work

We usually advise taking between 6 to 12 weeks off work, depending on the type of work you do. Your GP will help you decide when to go back to work when you see them for your fit note.

Medicines 

You will usually be sent home with an antiplatelet medicine (aspirin or clopidogrel) and a statin (such as atorvastatin), if you were not already taking them.

Follow-up appointment

You will need to have regular scans (CT and ultrasound scans) to make sure that the endograft is in the correct position. If you had a standard EVAR, you will need a scan after about 3 months. If you had FEVAR or BEVAR, you will need a scan after 4 to 6 weeks. Your scan might be earlier depending on your situation. Your scan might be before your follow-up appointment.

Your follow-up appointment will be with your surgeon 4 months after an EVAR. We will try to make sure this is at your local hospital, but this is not always possible. To make sure everyone always has up-to-date information about your health, we might share information about you between the hospitals. Ask your team if you have any concerns about this.