Minimally invasive, catheter-based stent grafting that repairs abdominal and thoracic aortic aneurysms from inside the blood vessel — without open chest or abdominal surgery.
The aorta is the largest artery in the body, carrying oxygen-rich blood from the heart to everywhere else. An aneurysm is a localised, abnormal bulge in the wall of the artery caused by weakening of that wall over time. As an aneurysm enlarges, the tension on its stretched, weakened wall increases, and beyond a certain size the risk of sudden rupture — a medical emergency with a very high mortality rate — rises sharply. Because aneurysms typically grow silently over years without causing symptoms, most are found incidentally on a scan done for another reason, or through a targeted screening ultrasound.
Aneurysms are named for where they occur: an abdominal aortic aneurysm (AAA) affects the portion of the aorta running through the belly, while a thoracic aortic aneurysm affects the portion running through the chest. Some patients have aneurysms spanning both regions.
Small aneurysms are monitored with periodic ultrasound or CT rather than repaired immediately.
Considered at around 5.5cm (men) / 5.0cm (women) for an abdominal aneurysm, or around 6cm for a thoracic aneurysm.
Regardless of size, if the aneurysm is growing quickly, causing symptoms, leaking, or has ruptured.
A fabric-covered metal stent graft is delivered through small punctures in the groin arteries.
The graft is guided up to the aneurysm under X-ray guidance and precisely positioned.
The graft expands to form a new, sealed channel, taking pressure off the aneurysm sac.
Regular follow-up imaging confirms the seal is holding and the sac is stable or shrinking.
Aortic aneurysms are more common in older adults, smokers, men, and people with high blood pressure, atherosclerosis, or a family history of aneurysm disease; certain inherited connective tissue conditions also raise the risk, particularly for thoracic aneurysms. Most abdominal aortic aneurysms are picked up incidentally on an ultrasound, CT, or MRI done for an unrelated reason, since they rarely cause symptoms until they become very large or start to leak. A CT angiogram is the key study used to confirm the diagnosis and plan treatment, since it maps the aneurysm's exact size, shape, and its relationship to the major branch arteries — critical information for deciding whether, and how, endovascular repair can be done.
Not every aneurysm needs immediate treatment — small aneurysms are generally followed with regular surveillance imaging rather than repaired right away, since the risk of surgery can outweigh the risk of rupture at smaller sizes. Elective repair is typically considered once an aneurysm reaches a size where the rupture risk starts to clearly outweigh the risk of treating it, which current guidance places at around 5.5 cm for men and 5.0 cm for women for an abdominal aneurysm, and around 6 cm for a descending thoracic aneurysm. Repair is also considered, regardless of size, if the aneurysm is growing quickly, causing pain or other symptoms, or has begun to leak — and is performed urgently in the setting of rupture or acute dissection.
Surveillance below the threshold: smaller aneurysms are monitored with periodic ultrasound or CT, typically annually for smaller aneurysms and every six months as they approach the size where repair becomes appropriate.
Elective repair at threshold: once size, growth rate, or symptoms indicate treatment, the choice between endovascular and open repair is individualised based on the aneurysm's anatomy and the patient's overall fitness for each approach.
EVAR and TEVAR are minimally invasive, catheter-based techniques that repair an aneurysm from inside the blood vessel, without cutting open the chest or abdomen. A fabric-covered metal stent graft is delivered, collapsed inside a thin sheath, through small punctures in the femoral arteries in the groin, and guided up to the aneurysm under X-ray guidance. Once correctly positioned, the graft is deployed and expands to form a new, sealed channel for blood flow — lining the inside of the weakened aortic wall and taking the pressure of blood flow off the aneurysm sac itself, so it's no longer directly exposed to the full force of arterial pressure.
EVAR treats aneurysms of the abdominal aorta, most often just below where the kidney (renal) arteries branch off.
TEVAR treats aneurysms of the descending thoracic aorta — the part of the aorta running down through the chest. Aneurysms very close to the heart, in the aortic root or ascending aorta, generally still require open surgery.
The procedure is typically performed under general or regional anaesthesia and takes one to a few hours depending on complexity. Most patients spend a few days in hospital afterward, considerably less than the recovery time needed after open surgical repair.
Both endovascular and open repair aim to prevent rupture, but they differ meaningfully in what the patient goes through. Endovascular repair, done through small groin punctures, is associated with less blood loss, a shorter hospital stay, and a faster return to normal activity, along with a lower risk of complications around the time of the procedure compared with open surgery, which requires a large abdominal or chest incision and a longer recovery. The trade-off is that endovascular repair requires committed long-term imaging follow-up to make sure the graft continues to seal the aneurysm properly, whereas the durability of a well-performed open repair tends to need less ongoing surveillance. Not every patient or every aneurysm is anatomically suited to an endovascular approach — the decision is made individually, based on the aneurysm's shape and location and the patient's overall fitness for either procedure.
Because the stent graft works by sealing off the aneurysm sac from blood flow, regular follow-up imaging — usually CT, sometimes ultrasound — is scheduled after EVAR or TEVAR to confirm the seal is holding and the aneurysm sac is stable or shrinking. The main thing this surveillance watches for is an endoleak: persistent blood flow into the aneurysm sac around or through the graft, despite the repair. Endoleaks are graded by their cause and are managed differently — some are watched, since certain types can resolve on their own, while others need a further procedure to seal the leak and protect the repair. This is why lifelong follow-up, even after a successful procedure, is considered part of the treatment itself rather than optional aftercare.
Endovascular aortic repair depends on precise pre-procedure planning — accurately measuring the aneurysm and surrounding vessels to select and size the right graft — and on technical precision during deployment, since the margin for error around the major branch arteries near the aneurysm is often small. Long-term success depends just as much on a structured, well-run surveillance programme afterward, which is why aortic aneurysm care is best delivered by a team with specific experience across planning, procedure, and follow-up, rather than any one part of that pathway in isolation.
EVAR treats aneurysms of the abdominal aorta; TEVAR treats aneurysms of the thoracic (chest) aorta. Both use the same basic technique — a stent graft delivered through the groin arteries — just in different segments of the aorta.
As a general guide, elective repair is considered around 5.5 cm for men and 5.0 cm for an abdominal aneurysm in women, or around 6 cm for a thoracic aneurysm — or sooner if it's growing quickly or causing symptoms. Smaller aneurysms are typically monitored with regular surveillance imaging rather than repaired immediately.
It's far less invasive than open surgical repair — performed through small punctures in the groin rather than a large chest or abdominal incision — though it's still a significant procedure requiring anaesthesia and hospital-based care.
Most patients spend a few days in hospital and return to normal activities considerably faster than after open surgery, though exact recovery time depends on the individual case and overall health.
Yes — regular imaging, usually CT, is scheduled afterward to confirm the graft is sealing the aneurysm properly and to check for an endoleak. This surveillance is considered a permanent part of aftercare, not a one-time check.
Book a consultation with Dr. Giragani, or send your scans for a specialist second opinion.