Aortic Aneurysm Treatments 

If you are diagnosed with an aortic aneurysm, you're in the right place at UMass Memorial Medical Center in Worcester, MA. We are a nationwide leader in the repair of complex aortic aneurysms. Our Center for Complex Aortic Disease is one of only a handful of centers in the United States performing fenestrated endovascular aortic repair (FEVAR), which uses small holes in the endograft for a customized graft.

Our vascular surgeons are the first in the U.S. to perform an aneurysm repair with a new technology that uses fiber optic cable imaging instead of X-ray radiation ... Safer for the patient and safer for the staff.

Treatment of aortic aneurysms is determined according to the severity and size of your aneurysm. Options include:

• Endovascular stent graft repair – Also called endovascular repair (EVAR), this is a less invasive procedure than open surgery that involves the placement of a covered stent to better support the lining of the aneurysm to keep it from bursting. This includes fenestrated (branched) endovascular repair for complex aneurysms.
• Open surgical aneurysm repair – For patients not appropriate for minimally invasive procedures, an aortic graft (a durable tube) replaces the weakened segment of the artery to keep it from bursting.
• Surveillance – Sometimes monitoring the aneurysm by your surgeon is the best option.
• Research studies/clinical trials – Sometimes, complex aneurysms cannot be treated by an FDA-approved device. In that case, you may qualify to be in a research study. Learn more about studies and trials for aortic aneurysms.

Watch a short video about the types of aneurysm repair.

What is Endovascular Aortic Repair (EVAR)?

EVAR is a minimally invasive alternative to an open repair. This approach allows for a faster recovery and less pain. An expandable stent graft is delivered to the area of the aneurysm through the major blood vessels using wires and catheters. Once it’s in place, it’s expanded into position.

Image of EVAR graft
Permission for use granted by Cook Medical, Bloomington, Indiana

What is Fenestrated Endovascular Aortic Repair (FEVAR)?

Some aneurysms are called complex aneurysms. These aneurysms include portions of the aorta with branch arteries that supply blood to organs like the kidneys and intestines.

A special type of repair is required to preserve flow to these branch arteries: a fenestrated endovascular aortic repair (FEVAR), which uses small holes in the endograft for a customized graft. Special holes are designed in the graft at the precise location that these arteries arise. The fenestrated endograft is designed specifically to fit each patient’s particular anatomy. This is possible through the use of sophisticated imaging software that allows our team to manipulate CT images.

Watch an animation of FEVAR.
Permission for use granted by Cook Medical, Bloomington, Indiana

What are the Benefits of FEVAR?

Benefits include:

• Avoiding a large incision in the abdomen or chest resulting in a quicker recovery
• Reducing risk of lung, heart or abdominal problems
• Reducing risk of infection due to the small incisions
• Having a shorter hospital stay

Endovascular repair of a complex aneurysm will take about two to six hours depending on your anatomy. Open surgery for the same type of aneurysm would take about the same amount of time or longer but would be very complex and high risk.

Some patients who don't qualify for open surgery due to medical problems may qualify for endovascular surgery.

If your doctor recommends endovascular repair, learn about care before, during and after the procedure. 

What is Involved in Open Surgical Repair of a Complex Aneurysm?

In an open repair of an aortic aneurysm, a large incision is made at the location of the aneurysm. If the aneurysm is in your chest, you will be placed on cardiopulmonary bypass (a pump that temporarily takes over the function of the heart and lungs during surgery). If the aneurysm is in your abdomen, clamps will be used to stop the blood flow through your aorta while a fabric tube is sewn to healthy tissue above and below the aneurysm. Smaller grafts are sewn on to the graft and connected to the blood vessels that lead to the kidneys, intestines and liver. Once these connections are made, the clamps are removed, and blood is allowed to flow back through the repaired aorta.

Your surgeon can give you more information about the risks of this surgery. You’ll need to spend several days in the intensive care unit followed by another three to 10 days in the hospital. Most patients will require some time in a rehabilitation hospital. It’s important to know that some patients don’t qualify for open surgery because of significant heart or lung disease, or previous abdominal or thoracic surgery.