Endovascular aneurysm repair (EVAR)

What is endovascular aneurysm repair (EVAR)?

The aorta is the main artery carrying blood from the heart down through the body. An abdominal aortic aneurysm (AAA) is a swollen, weakened section of the aorta in the tummy that can burst (rupture) as it grows, which is often fatal.

EVAR is a keyhole way of repairing an aneurysm from the inside, without a large tummy incision. Through small cuts or punctures in the groin arteries, the surgeon uses X-ray guidance to pass a folded fabric-and-metal tube (a stent graft) up into the aorta. The graft is opened out and anchored above and below the aneurysm, so blood flows through the new lining and the pressure on the weakened wall is taken away.

Most aneurysms cause no symptoms and are found through the NHS screening programme (which invites men at 65) or by chance on a scan. Repair is generally considered when an aneurysm reaches about 5.5 cm across, is growing quickly, or causes symptoms.

EVAR usually has a quicker recovery and a lower early risk than open surgery, but it depends on the aneurysm having a suitable shape, it can leak around the graft (an 'endoleak'), and it needs lifelong scans and sometimes further procedures. UK guidance (NICE) recommends open repair as the usual choice for most fit people with a standard aneurysm, with EVAR considered when open surgery is too risky or the anatomy suits a keyhole repair.

Types, options & approaches

There may be different ways to do this. The right approach depends on the clinical question and your circumstances.

EVAR (keyhole) vs open repair

NICE recommends open repair for most fit people with a standard aneurysm, with EVAR when open surgery is too risky or unsuitable. The right choice depends on your anatomy, age and fitness.

Preparing for your procedure

• Expect a detailed CT scan of the aorta, which decides whether your aneurysm's shape is suitable for EVAR, plus heart, lung and blood tests.
• Stop smoking as early as possible — it affects healing, heart and lung risk, and aneurysm disease.
• Discuss all medicines; blood thinners and some heart, diabetes and blood-pressure medicines need a clear plan.
• Optimise heart, blood pressure, diabetes and kidney health beforehand, as X-ray dye can stress the kidneys.
• Arrange a few weeks of lighter activity and some help at home for the early recovery.
• Make sure you understand that EVAR needs lifelong follow-up scans and may need further procedures.
• Discuss the alternative of open repair and what happens if you choose not to have any repair.

What happens

EVAR is done in an operating theatre or a special X-ray theatre. Depending on you and the case, it may be under general anaesthetic, a spinal/epidural, or sometimes local anaesthetic with sedation.

The surgeon reaches the arteries in your groin through small cuts or needle punctures. Using X-ray guidance and dye to see the aorta, they pass the folded stent graft up through the artery to the aneurysm. The graft is carefully positioned and then opened out, anchoring to healthy aorta above and below so blood is rerouted through it and the aneurysm sac is sealed off from the pressure of the blood.

A check X-ray confirms the graft is in the right place and looks for any leak around it. The groin is closed and you are usually monitored for a few days. Recovery is generally quicker than after open surgery, but you will need follow-up scans for the rest of your life.

Is this procedure right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

Comfort, sedation or contrast choices

If local anaesthetic, sedation, contrast or pain relief is used, ask what is planned, why, and what it means afterwards.

EVAR usually has a lower early risk than open surgery, but it brings its own long-term issues: leaks around the graft (endoleaks), graft movement, and the need for lifelong scans and sometimes further procedures. Crucially, if monitoring is missed, an untreated endoleak can let the aneurysm keep growing and eventually burst — so committing to follow-up is part of choosing EVAR. Ask about your aneurysm's suitability, your kidney function and the follow-up plan.

Published figures to discuss

Risk depends on whether the procedure is planned or an emergency, your fitness, your kidney function and the aneurysm's anatomy. Figures below come from trials and large series and should be read as ranges. EVAR tends to have a lower early death rate than open repair but more procedures over time; emergency repair carries a much higher risk. Your surgeon can give a personalised estimate.

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

What happens afterwards

Recovery from EVAR is usually quicker than open surgery. Most people stay in hospital for a few days and return to normal activities within a few weeks, but everyone needs ongoing follow-up scans afterwards.

• Bruising and tenderness in the groin where the arteries were reached
• Tiredness and reduced stamina for a few weeks
• Gradual return to normal activity over weeks rather than days
• Needing to attend regular follow-up scans long term
• Mild swelling or numbness near the groin wounds that settles

Aftercare

• Look after the groin wounds and follow advice on showering and dressings.
• Build up gentle activity and avoid heavy lifting in the first weeks.
• Follow advice on when you can drive again and check with your insurer.
• Drink enough fluids to help your kidneys recover from the X-ray dye.
• Take medicines to protect your heart and arteries (such as blood-pressure and cholesterol treatment) as prescribed.
• Stop smoking and keep blood pressure and cholesterol controlled to protect the rest of your arteries.
• Attend every follow-up scan — this is essential after EVAR — and know who to contact about problems.

• CT scan confirming suitable aneurysm shape for EVAR
• Kidney function and heart/lung assessment done
• Smoking stopped or cut down as much as possible
• Plan for medicines, including blood thinners, agreed
• Commitment and arrangements for lifelong follow-up scans understood
• Transport home and support for the first weeks organised
• Vascular team and out-of-hours contact details saved

Scars and how they heal

EVAR is done through small groin cuts or needle punctures rather than a large incision. These usually heal to small marks, with bruising that fades over weeks. Occasionally a groin wound develops a collection or infection that needs treatment, and a small lump or numb patch can remain.

⚠ Get urgent help if…

• Sudden severe tummy or back pain, feeling faint or collapsing — call 999, this is an emergency
• A cold, pale or painful leg or foot after the procedure
• A groin wound that is increasingly red, swollen, leaking, very painful, or a fever (signs of infection)
• A pulsating or rapidly swelling lump in the groin
• Chest pain, severe breathlessness or palpitations — call 999
• Much reduced urine, or black or bloody stools and severe tummy pain

Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your surgeon gives you.

Results & realistic expectations

A good result means the stent graft seals the aneurysm from the pressure of the blood, the sac stops growing (and often shrinks), and the risk of rupture is greatly reduced. A check scan after the procedure, and the first follow-up scans, confirm the graft is in place and look for leaks.

EVAR depends on continued monitoring. Leaks around the graft (endoleaks) or graft movement can develop over time and may allow the aneurysm to grow again, occasionally to the point of bursting, if not picked up and treated. This is why lifelong follow-up is part of the treatment, not an optional extra. As with open repair, EVAR does not cure the wider artery disease, so risk-factor control remains important.

EVAR can give a durable repair, but it is less 'fit and forget' than open surgery. Over the years, endoleaks, graft movement or material fatigue mean further procedures are needed more often than after open repair — studies report secondary procedures in a meaningful minority of people. With good follow-up, many problems can be treated before they become dangerous. The wider artery disease continues, so lifelong attention to risk factors and medicines matters.

Related tests, treatments or support

Around the procedure, your team will assess and manage your heart, lungs, kidneys and other arteries, because aneurysm disease often goes with disease elsewhere. Complex aneurysms involving the kidney or gut arteries may need custom (fenestrated or branched) grafts, which are more specialised. Stopping smoking and treating blood pressure and cholesterol are part of the overall plan.

Follow-up & long-term care

Lifelong surveillance is central to EVAR: you will have regular scans (often ultrasound or CT) to check the graft position and look for endoleaks, with the schedule set by your unit. Further procedures can be done through the groin if a problem is found. Report any sudden severe tummy or back pain, groin wound problems, or a cold painful leg urgently, and do not skip surveillance scans.

• Attend every follow-up surveillance scan for life — this is essential after EVAR
• Take heart- and artery-protecting medicines as prescribed
• Stop smoking and keep blood pressure and cholesterol controlled
• Stay active and keep to a healthy weight within your team's advice
• Seek urgent help for sudden severe tummy or back pain at any time

Repeat, follow-on and what comes next

• Further procedures, usually through the groin, are needed more often than after open repair, mainly for endoleaks or graft movement.
• Lifelong surveillance scans are part of the treatment, not optional.
• Some people are later converted to open surgery if EVAR problems cannot be fixed by keyhole means.
• The early survival advantage of EVAR over open repair tends to narrow over the years, partly because of these later issues.

Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.

What good aftercare looks like

• A clear, lifelong surveillance scan programme with reminders and a named contact.
• Care in a specialist vascular unit able to treat endoleaks and graft problems if they arise.
• A recovery plan covering groin wound care, activity, driving and return to work.
• Ongoing management of artery risk factors (smoking, blood pressure, cholesterol) and protective medicines.
• An urgent route for sudden severe tummy or back pain, groin problems or a cold painful leg.

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

• The stent graft device used, including custom (fenestrated/branched) grafts for complex aneurysms
• The complexity of the aneurysm and the procedure time
• Imaging before, during and after, plus lifelong surveillance scans
• The anaesthetic type and length of hospital stay
• The surgical/interventional team and hospital facility fees
• Any further procedures needed for endoleaks or graft problems
• Ongoing management of artery risk factors

• The surgeon's/interventionist's and anaesthetist's fees and the facility fee
• The cost of the stent graft device (and any custom graft)
• Imaging before and after, and the lifelong surveillance scan programme
• What is covered if an endoleak or graft problem needs a further procedure
• Expected length of stay and what happens if a complication occurs
• Follow-up appointments and who provides long-term surveillance
• Cancellation policy and arrangements if the procedure is postponed for fitness reasons

On the NHS? EVAR is provided on the NHS when national size, growth or symptom criteria are met, most often where open surgery is too risky or the anatomy suits a keyhole repair; this is specialist treatment rather than a typical self-pay procedure.

You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.

Consent traps and marketing red flags

These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.

Choosing a specialist safely

• Check the surgeon is on the GMC Specialist Register for this area.
• Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
• You're entitled to time to consider and to have your questions answered before you agree — the surgeon who looks after you should explain it, not a salesperson.
• Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
• You're entitled to your total cost in writing — including any follow-up — before you decide.

How Vuemedics verifies every consultant →

Take this to your consultation. A good surgeon will welcome every one of these.

• Is my aneurysm's shape suitable for EVAR, and how does that compare with open repair for me?
• What is my personal estimated risk from EVAR, given my heart, kidneys and fitness?
• What does the lifelong follow-up scan schedule involve, and what if I cannot attend?
• How likely am I to need a further procedure, and what would that involve?
• How will my kidneys be protected from the X-ray dye?
• What are the risks if I choose open repair instead, or no repair at all?
• Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
• Will you be the surgeon who carries out my procedure, and who looks after me afterwards?
• What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
• What does a realistic result look like — and what can this procedure not achieve?
• What are my options, including waiting, doing nothing for now, or choosing a different approach?
• Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
• What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

Find a verified surgeon for endovascular aneurysm repair (evar)

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How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: NHS — Abdominal aortic aneurysm NICE NG156 — Abdominal aortic aneurysm: diagnosis and management Circulation Foundation (Vascular Society) — Abdominal aortic aneurysm EVAR trial 1 — EVAR vs open repair, 30-day mortality (PubMed) EVAR vs open repair, long-term outcomes (EVAR trial 1) — PubMed EVAR trial 1 — 15-year follow-up (PubMed) Cleveland Clinic — Endoleak after EVAR NHS — Abdominal aortic aneurysm screening

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.