Vascular Surgery

Endovascular Aneurysm Repair (EVAR)

An abdominal aortic aneurysm (AAA) is a swelling or ballooning of the main artery leading from the heart to supply the abdominal viscera and lower limbs. It is commoner in men and usually does not cause any symptoms. However without treatment when an aneurysm reaches a certain size there is a risk it might burst or rupture. This usually causes a catastrophic loss of blood and can be fatal. To prevent this it is recommended that an aneurysm be repaired when it reaches 5.5 cm diameter. Traditionally this was done using the open method in which a long incision was made in the abdomen and the aneurysm replaced with an artificial material.

Although this is a reliable and durable procedure it is associated with a death rate of 5-10%, a hospital stay of 10 days and a prolonged recovery. More recently a newer way of repairing aneurysms has emerged called Endovascular Aneurysm Repair (EVAR). This technique involves a stent being introduced from one of the groin arteries and being used to seal the aneurysm from within. The scar is much smaller consisting of a small incision in each groin. This technique has a better survival rate, a quicker recovery and fewer days in hospital. The first EVAR in North East Essex was performed in Colchester Hospital on 1st May 2007 and since then over 80 EVARs have been performed.

Since the introduction of this technique the death rate of scheduled aneurysm repair has fallen dramatically to about 1% over the past two years, better than the national average. Colchester hospital performs many aneurysm repairs and is ranked 3rd in the Strategic Health Authority for the number of aneurysm repairs performed by hospital. In the future it is likely that Colchester will be performing more complex EVAR procedures which will benefit patients as well as trainee surgeons wishing to gain experience in this technique.

Colchester Hospital, as part of the Five Rivers Vascular Network is also at the forefront of local implementation of the national AAA screening program for the populations of North East Essex and Suffolk. When implemented this will result in fewer aneurysms presenting as an emergency with a burst aneurysm and increase the number of scheduled AAA repairs in Colchester even further.