Endovascular aneurysm repair (EVAR) is a minimally invasive procedure in which an aortic aneurysm — a dangerous ballooning of the body's main artery — is excluded from blood flow using a fabric-covered stent graft delivered through small punctures in the femoral arteries. Instead of opening the abdomen to sew in a surgical graft, the physician navigates the folded device through the bloodstream under X-ray guidance and expands it inside the aneurysm, creating a new, reinforced channel for blood. EVAR has become the dominant first-line approach for anatomically suitable abdominal aortic aneurysms because it avoids a large incision, aortic cross-clamping, and the prolonged recovery of open repair.
What Does EVAR Stand For?
EVAR stands for EndoVascular Aneurysm Repair. "Endovascular" means the treatment is performed from inside the blood vessel: the entire repair is delivered through catheters advanced from the groin, so the aneurysm itself is never surgically exposed. When the same principle is applied to the thoracic (chest) portion of the aorta, the procedure is called TEVAR — thoracic endovascular aortic repair.
How the EVAR Procedure Works
An EVAR procedure typically follows a consistent sequence. Both femoral arteries are accessed percutaneously or through small groin incisions. Guidewires and delivery sheaths are advanced into the aorta under fluoroscopic imaging, and contrast angiography maps the aneurysm and its branch vessels. The main body of the stent graft is positioned just below the renal arteries and deployed, anchoring to healthy aortic wall above the aneurysm. Limb extensions are then joined to carry blood into each iliac artery. When the seal is complete, blood flows only through the graft, and the excluded aneurysm sac is depressurized, which removes the driving force behind rupture.
EVAR vs Open Surgical Repair
Randomized trials comparing EVAR with open surgery — including the landmark EVAR-1, DREAM, and OVER studies — consistently showed lower perioperative mortality and faster recovery with the endovascular approach, with hospital stays measured in days rather than weeks. Over longer follow-up, survival between the two strategies converges, and EVAR carries a higher likelihood of reintervention, which is why lifelong imaging surveillance is part of the endovascular pathway. The choice between approaches is individualized: anatomy, age, fitness for open surgery, and patient preference all enter the decision.
Who Is a Candidate for EVAR?
Suitability is determined primarily by anatomy on CT angiography. Key criteria include an adequate infrarenal neck — the segment of healthy aorta below the renal arteries where the graft must seal — acceptable neck angulation, and iliac arteries large and straight enough to accommodate the delivery system. Patients whose anatomy falls outside standard criteria may still be treated with advanced techniques or alternative device concepts. A detailed discussion of patient selection is available in our article on who qualifies for endovascular aneurysm repair.
Devices Used in EVAR
The core EVAR device is the stent graft: a self-expanding metal skeleton covered with surgical fabric, built as a main aortic body plus modular iliac limbs. Device families differ in fixation method (suprarenal hooks versus infrarenal friction), profile of the delivery system, and the range of neck anatomies they accommodate. INVAMED's aortic aneurysm and dissection repair portfolio spans EVAR and TEVAR stent grafts together with the STENA Aortic Multi-Layer Flow Modulator (MFM) — a branch-preserving, uncovered flow-modulating stent concept described in peer-reviewed literature for complex aneurysm anatomies where conventional covered grafts are challenging. Device selection is always made by the treating physician based on anatomy and the device's Instructions for Use.
EVAR vs TEVAR
EVAR treats aneurysms of the abdominal aorta; TEVAR applies the same stent-graft principle to the descending thoracic aorta, including thoracic aneurysms and selected type B dissections. TEVAR devices are larger in diameter and must perform in a segment of the aorta exposed to higher pulsatile stress. Our overview of thoracic endovascular aortic repair (TEVAR) covers the differences in detail.
Risks, Endoleaks, and Lifelong Surveillance
The most characteristic finding after EVAR is the endoleak — persistent blood flow into the aneurysm sac outside the graft. Endoleaks are classified by their source (types I through V); many are benign or resolve spontaneously, while others, particularly type I and type III, require treatment to restore sac exclusion. Because of this possibility, EVAR patients enter a structured imaging surveillance program, typically with CT or duplex ultrasound at defined intervals. Reintervention, when needed, is usually also endovascular. A complete review is available in our article on potential complications of EVAR and TEVAR.
Frequently Asked Questions
Is EVAR considered major surgery?
EVAR is a major aortic procedure, but it is minimally invasive: there is no open abdominal incision and no aortic cross-clamping. Most patients are walking within a day and leave hospital within one to three days, compared with a week or more after open repair.
What is the recovery time after EVAR?
Most patients return to normal light activity within two to four weeks. Recovery is discussed step by step in our guide to EVAR recovery time.
How long does an EVAR stent graft last?
Modern stent grafts are designed for permanent implantation. Durability is monitored through lifelong imaging surveillance, because a minority of patients develop endoleaks or graft migration that require secondary procedures.
What does EVAR mean in a medical report?
In clinical notes, "EVAR" simply denotes that an abdominal aortic aneurysm was, or will be, treated with an endovascular stent graft rather than open surgery.
Related on INVAMED
Further reading: emergency EVAR for ruptured AAA, recovery after endovascular aneurysm repair, and TEVAR for type B dissection. The full device range is on the aortic portfolio page.
Device availability and regulatory status vary by country. Please contact INVAMED or your authorized local distributor for current regulatory information applicable to your region.