Open surgery provides the best result in the long term but is a major surgery procedure carrying with it a mortality risk of around 5% and a recovery period lasting weeks to months. Due to the traumatic nature of open-surgery, many patients are not strong enough to undergo the procedure, for example due to old age or cardiovascular disease.

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EVAR is a much less invasive procedure with patients generally discharged from hospital within 1 to 5 days.  However, there are a number of disadvantages, both for the hospital/healthcare system and for the patient:
 

• Many patients are ineligible:
  - The anatomy of the aneurysm can make it too difficult for the stent graft to be positioned, for example because there is too short a distance to the renal arteries (short neck)
  - The blood vessels are too tortuous or narrow for the device (smallest in Europe is 16 French)
   

• Lifetime surveillance is required with secondary interventions needed in 20 to 30% of cases due to:
  - Endoleaks (blood entering the aneurysm either around the stent (type I) or from smaller side branches within the aneurysm (type II)) – aortic sac enlargement has been measured in 21% of EVAR patients after 5 years.
  - Migration or kinking of the devices
   

• It is still a surgical procedure often requiring a cut-down in the groin.
  - Damage can occur to the femoral artery through which the device is pushed requiring repair before closure, with all its possible and also post-operative complications such as incision site infections.

 

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