It's Topic Tuesday!

Good morning, Aortic Hope community! My name is Jared Lin and today, we are continuing our theme of addressing common myths and misconceptions about aortic disease.

The myth for today is:

“The only way to fix an abdominal aortic aneurysm is through open surgery.”

For many patients, hearing the words “aortic aneurysm” can be scary enough. Hearing that it may need surgery can make it feel even more overwhelming. People may picture a large incision, a long hospital stay, and a major open operation.

While open surgery is one important way to repair an abdominal aortic aneurysm, it is not the only way.

Today, many patients may be candidates for a less invasive option called endovascular aneurysm repair, often shortened to EVAR (abdominal) or TEVAR (thoracic)

So where Does This Myth Come From?

For many years, open surgical repair was the main way to treat abdominal aortic aneurysms.

During open repair, the surgeon makes an incision in the abdomen, reaches the aneurysm directly, and replaces the weakened portion of the aorta with a graft.

Because this was historically the traditional approach, many people still assume that fixing an abdominal aortic aneurysm always requires a large open surgery.

But vascular surgery has changed dramatically over time.

Thanks to advances in imaging, devices, and minimally invasive techniques, some abdominal aortic aneurysms can now be repaired from inside the blood vessel.

What Actually Happens During (T)EVAR?

(T)EVAR stands for endovascular aneurysm repair: “Endovascular” means “inside the blood vessel.”

Instead of opening the abdomen to directly reach the aneurysm, the surgeon usually makes small incisions or punctures near the groin to access the arteries.

A stent graft is then guided through the blood vessels and positioned inside the weakened part of the aorta.

Think of it like creating a new pathway for blood to flow through.

The stent graft helps redirect blood away from the bulging aneurysm wall, reducing pressure on that weakened area and lowering the risk of rupture.

🩺 Open repair works from the outside.

🩻 (T)EVAR works from the inside.

Both approaches have the same major goal: to prevent the aneurysm from rupturing.

Why Might (T)EVAR Be Chosen?

(T)EVAR may be a good option for some patients because it is less invasive than open surgery.

Potential benefits may include:

• Smaller incisions

• Shorter hospital stay

• Faster early recovery

• Less stress on the body during the procedure

• An option for some patients who may be higher-risk for open surgery

This can be especially meaningful for patients who are older, have lung disease, heart disease, or other medical conditions that make a large open operation more challenging.

So Why Doesn’t Everyone Get an (T)EVAR?

This is the important part: (T)EVAR is not right for every abdominal aortic aneurysm.

A patient’s anatomy matters.

The size, shape, and location of the aneurysm all affect whether a stent graft can be safely placed. Doctors also look at the arteries above and below the aneurysm, including the arteries near the kidneys and the arteries in the pelvis and legs.

Some patients may not have enough healthy aorta for the stent graft to seal properly.

Others may have aneurysms that are too complex for a standard (T)EVAR.

In those cases, open repair may still be the safest or most durable option.

Open Surgery Still Matters

Even though (T)EVAR is a major advancement, open repair remains an important and lifesaving treatment.

Open surgery may be recommended when:

• The aneurysm anatomy is not suitable for (T)EVAR

• The aneurysm involves important branch vessels

• The patient is young and needs a durable long-term repair

• Prior stents or surgeries make repair more complex

• The surgeon believes open repair offers the safest outcome

Open repair is not “old-fashioned.” It is still a powerful and necessary tool in aortic care.

The best repair is not the newest repair or the smallest incision.

The best repair is the one that is safest and most appropriate for that individual patient.

Follow-Up Is Still Important

Another common misconception is that once an aneurysm is repaired, the patient is “done.”

After (T)EVAR, patients usually need lifelong imaging follow-up to make sure the stent graft remains in the right position and the aneurysm sac is not still receiving blood flow.

This is why continued care with a vascular specialist is so important.

Even after repair, surveillance matters.

The Takeaway

The myth that abdominal aortic aneurysms can only be fixed with open surgery is not true.

Today, many patients may have more than one possible repair option, including (T)EVAR.

But treatment decisions depend on the aneurysm, the patient’s anatomy, overall health, and the expertise of the care team.

🫀 Open surgery saves lives.

🩻 (T)EVAR also saves lives.

🩺 The right team helps decide which option is best.

If you or someone you love has been diagnosed with an abdominal aortic aneurysm, make sure you ask questions. Learn about the size and location of the aneurysm. Ask whether (T)EVAR, open repair, or continued monitoring is most appropriate.

Awareness does not just help us understand the diagnosis . . . It helps us understand the options.

Signing off as your friend,

Jared Lin

Wayne State Medical Student

#TopicTuesday #AorticHope #AorticAwareness