Understanding endovascular aneurysm repair
Barbra A. Buckley RN

September 2012 
Volume 42  Number 9
Pages 35 - 38
  PDF Version Available!

OPEN ABDOMINAL aortic aneurysm (AAA) repair has been performed successfully for decades. A newer, minimally invasive alternative to traditional open surgery, endovascular aneurysm repair (EVAR), is now being performed regularly for elective AAA repair. This article will take a look at how EVAR can treat a potentially life-threatening AAA and what nurses can do to ensure a successful outcome.An aneurysm is defined as a pathologic focal (localized) dilatation of a segment of a blood vessel. Aortic aneurysms are defined as a 50% increase in the diameter of a segment of the aorta compared to normal sections.1Aneurysms can be described as true or false. True aneurysms involve all three layers of the vessel wall-the tunica intima (inner layer), the tunica media (middle layer), and the tunica externa or tunica adventitia (outer layer), which remain intact in an uncomplicated aneurysm.2 (See An inside look at vessel walls for more detail.) A true aneurysm is bounded by a complete vessel wall and the blood remains within the vascular compartment.3A false aneurysm or pseudoaneurysm, unlike a true aneurysm, involves a disruption (dissection or tear) in the intima, or the intima and media layers, with extravascular hematoma formation that causes vessel enlargement. False aneurysms are bounded only by the outer layers of the vessel wall or supporting tissues.3Aortic aneurysms may also be classified according to their appearance. A fusiform aneurysm involves the entire circumference of the vessel segment, giving it a fairly symmetrical appearance. Fusiform aneurysms are characterized by a gradual and progressive dilation of the vessel.3 A saccular aneurysm involves only a portion of the circumference, resulting in an outpouching of the vessel wall and a "saclike" appearance.3 (See Tracing aortic anatomy.)Aortic aneurysms are also classified according to their location. Approximately 25% of aortic aneurysms are thoracic; the remainder are abdominal.4 Ninety percent of AAAs are infrarenal

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