EVAR Procedure at Apollo Hospitals, Lucknow

Why Patients Choose Apollo Hospitals, Lucknow for EVAR

• Apollo Group legacy since 1983: Apollo Hospitals pioneered organised private healthcare in India and today operates a network of more than 70 hospitals, with cardiac and vascular services among its highest-volume specialities nationally.
• Dedicated vascular and endovascular team: Aortic work at Apollo Lucknow is handled by a combined team of vascular surgeons, cardiac surgeons, interventional radiologists and cardiac anaesthetists, so stent-graft cases are planned jointly rather than by a single operator.
• Cath-lab and hybrid imaging capability: EVAR is performed under high-resolution fluoroscopic guidance with digital subtraction angiography, and planning is done on multi-slice CT angiography with 3D centreline reconstruction ? the measurement standard recommended for stent-graft sizing.
• Full-spectrum aortic care: Infrarenal EVAR, iliac branch and bell-bottom configurations, endovascular repair of thoracic aneurysms (TEVAR), and open surgical repair when anatomy is unsuitable for a stent graft. Not every aneurysm is suitable for EVAR, and the team will say so.
• Critical care backup: 24x7 intensive care, blood bank access, dialysis support and on-site nephrology and cardiology cover ? important because most aneurysm patients are older and carry coronary, renal or lung disease.
• Emergency aortic response: 24x7 emergency services for suspected ruptured or symptomatic aneurysm, where time to imaging and time to theatre determine survival.
• Programmes tailored by patient group: pre-habilitation and cardiac risk optimisation for older and frail patients, structured lifelong imaging surveillance after EVAR, and referral pathways for the small number of younger patients with connective tissue disorders or infected (mycotic) aneurysms who need different planning.
• Insurance and TPA desk on site to handle cashless pre-authorisation for planned admissions and emergency intimation for ruptures.

Overview

The Endovascular Aneurysm Repair (EVAR) procedure is a minimally invasive surgical technique designed to treat abdominal aortic aneurysms (AAAs). At Apollo Hospitals Lucknow, we pride ourselves on our reputation for excellence in vascular surgery, utilising current technology and advanced techniques to work towards the best possible outcomes for our patients. Our team of skilled surgeons and medical professionals is dedicated to providing personalised care, making Apollo Hospitals Lucknow a well-equipped choice for the EVAR procedure in the region. With a focus on patient trust and satisfaction, we are committed to guiding you through every step of your treatment journey.

In simple terms, instead of opening the abdomen, the surgeon passes a fabric-covered metal stent graft through the groin arteries and positions it inside the aorta. The graft creates a new internal channel for blood, so pressure is taken off the weakened aneurysm wall and the risk of rupture falls sharply.

Why the EVAR Procedure is Necessary

An abdominal aortic aneurysm is a bulging or dilation of the aorta, the largest blood vessel in the body, which can lead to life-threatening complications if left untreated. The EVAR procedure is necessary to prevent the rupture of the aneurysm, which can result in severe internal bleeding and potentially fatal outcomes.

The benefits of the EVAR procedure include:

• Minimally invasive approach: Unlike traditional open surgery, EVAR involves small groin incisions or needle punctures, leading to reduced pain and quicker recovery times.
• Lower risk of early complications: The minimally invasive nature of the procedure generally results in fewer early complications than open surgery.
• Shorter hospital stay: Patients typically experience a shorter hospital stay, allowing a quicker return to daily activities.
• Improved quality of life: By effectively treating the aneurysm, EVAR can reduce the anxiety and restriction of living with an untreated aneurysm.

At Apollo Hospitals Lucknow, we understand the importance of timely intervention and the role it plays in achieving better outcomes for our patients.

Risks of Delay

Delaying the EVAR procedure once repair has been advised can have serious consequences. As an abdominal aortic aneurysm grows, the risk of rupture increases significantly. A ruptured aneurysm can lead to:

• Severe internal bleeding: This can result in shock and requires immediate emergency intervention.
• Increased mortality risk: The mortality of a ruptured aneurysm is very high, and a large proportion of patients do not survive long enough to reach a hospital.
• Complications from other health issues: Delaying treatment can allow heart, kidney or lung disease to worsen, making later surgery riskier.

At Apollo Hospitals Lucknow, we emphasise the urgency of timely treatment. Our team is available to assess you and advise whether repair, or continued surveillance, is the safer option in your case.

Benefits of the EVAR Procedure

Undergoing the EVAR procedure at Apollo Hospitals Lucknow offers several potential benefits, including:

• Reduced recovery time: Patients often recover faster than after open repair, returning to normal activities sooner.
• Less pain and discomfort: Smaller access sites usually mean less postoperative pain.
• Lower risk of wound infection: Smaller incisions reduce the risk associated with a long abdominal wound.
• Durable protection with follow-up: With appropriate patient selection and lifelong imaging surveillance, EVAR provides effective long-term protection against rupture for most patients. Some patients need a further, usually minor, endovascular top-up procedure over the years.

Choosing Apollo Hospitals Lucknow for your EVAR procedure means choosing a facility that prioritises your health and wellbeing and is honest with you about what the procedure can and cannot achieve.

Preparation and Recovery

Preparing for the EVAR procedure involves several important steps to ensure a smooth surgical experience.

Preparation tips

• Consultation: Schedule a thorough consultation with our vascular specialists to discuss your medical history, current health status and any concerns.
• Preoperative testing: You may need imaging, blood tests and cardiac evaluation to assess your overall health and the size and shape of the aneurysm.
• Medication management: Inform your doctor about all medicines you take. Some, such as certain blood thinners or diabetes tablets, may need to be adjusted or stopped before the procedure.
• Dietary adjustments: Follow the fasting and dietary instructions given by your healthcare team.

Recovery tips

• Follow postoperative instructions on activity levels, groin wound care and medication.
• Rest and hydration: Adequate rest and fluids support recovery, especially kidney recovery after contrast dye.
• Gradual return to activities: Resume normal activity in stages, avoiding heavy lifting and strenuous exercise initially.
• Attend follow-up appointments: Regular imaging follow-up is essential, not optional, after EVAR.

At Apollo Hospitals Lucknow, our team provides support throughout preparation and recovery so that you feel informed at every step.

Current Guidelines: When is Repair Advised?

Decision-making at Apollo Lucknow follows the internationally accepted thresholds that the Vascular Society of India (VSI) and Indian vascular practice align with, drawn from the European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Abdominal Aorto-Iliac Artery Aneurysms and the Society for Vascular Surgery (SVS) 2018 practice guidelines.

• Repair is generally advised for an infrarenal AAA of 55 mm or more in men, and at a lower threshold of around 50 mm in women, in whom rupture occurs at smaller diameters.
• Repair is also advised for rapid growth (more than about 10 mm in a year) or for a symptomatic or tender aneurysm, regardless of size.
• Below these thresholds, ultrasound surveillance at guideline-defined intervals is safer than operating. Early repair of small aneurysms has not been shown to improve survival.
• What changed recently: the ESVS 2024 update places stronger emphasis on treating patients only within the stent graft manufacturer's instructions for use, on shared decision-making in patients with limited life expectancy, and on structured lifelong post-EVAR surveillance because late complications and reinterventions accumulate over time. It also reiterates that in fit patients with long life expectancy, open repair remains a legitimate and sometimes preferable first choice.
• Guidelines also stress medical risk reduction for every aneurysm patient: complete smoking cessation, blood pressure control and statin plus antiplatelet therapy where indicated.

These are general thresholds. Your own recommendation depends on your anatomy, kidney function, heart status and personal preference.

Timing and the Pre-Procedure Preparation Phase

Planned EVAR is not a same-day decision. A typical pathway at Apollo Lucknow runs as follows.

A ruptured or symptomatic aneurysm bypasses all of this and is treated as an emergency.

EVAR Versus Other Technique Options

Additional Procedures Sometimes Done at the Same Time

• Iliac artery angioplasty or stenting to allow the delivery system to pass through narrow or calcified arteries.
• Internal iliac (hypogastric) artery embolisation when the graft must be extended into the external iliac artery.
• Endovascular conduit or surgical iliac conduit in patients with very small access vessels.
• Type II endoleak-related embolisation of feeding branches, sometimes planned at the index procedure.
• Femoral endarterectomy or patch repair if the groin artery is heavily diseased at the access site.
• Coronary intervention, if needed, is almost always done as a separate, earlier procedure rather than at the same sitting.

Phase-by-Phase Recovery Timeline

Timelines are indicative. Older patients, those with kidney or heart disease, and those who had complex or emergency repair may progress more slowly.

Returning to Normal Activity, Work and Exercise

• Walking: from day one, increasing daily. Walking is the single best rehabilitation activity after EVAR.
• Lifting: avoid loads above about 5 kg for 4?6 weeks to protect the groin puncture or wound. This includes lifting grandchildren, water cans and gas cylinders.
• Desk or supervisory work: commonly 2?4 weeks. Manual or field work: usually 6?8 weeks, sometimes longer.
• Driving: once you can perform an emergency stop without groin pain and are off sedating painkillers ? typically 2?4 weeks. Check your motor insurance conditions.
• Two-wheeler riding: defer longer than car driving because of vibration and groin strain over Indian road surfaces.
• Sexual activity: usually after 3?4 weeks. Some men notice ejaculatory changes after aortic surgery; ask your surgeon directly if this matters to you.
• Sport: low-impact activity (walking, swimming once wounds are healed, cycling, yoga without breath-holding) from around 6 weeks. Heavy weight training, competitive contact sport and straining exercises need specific clearance.
• Indian-specific postures: squatting, sitting cross-legged on the floor and using an Indian-style toilet all load the groin and hips. Use a Western commode or a commode chair for the first 3?4 weeks, and arrange floor-level sleeping to be moved to a cot at waist height if getting up from the floor is painful. A bedside chair beside a floor mattress helps if a cot is not available.
• Straining: avoid constipation. Chronic straining raises intra-abdominal pressure; a stool softener and adequate fluids for the first few weeks are worth it.

Preventing Progression and Recurrence

A stent graft treats the aneurysm; it does not treat the disease that caused it. Long-term protection depends on the following.

• Complete smoking and tobacco cessation ? including bidi, hookah, gutkha and khaini. This is the strongest modifiable factor for aneurysm growth and for new aneurysms elsewhere.
• Blood pressure control to target, with medicines taken daily and not intermittently.
• Statin and antiplatelet therapy as prescribed, for cardiovascular protection.
• Diabetes and weight management, and a diet lower in salt, fried food and refined carbohydrate.
• Lifelong imaging surveillance ? usually CT or duplex ultrasound at intervals set by your team, to detect endoleak, graft migration, limb kink or sac growth before it becomes dangerous.
• Screening of first-degree relatives: siblings and children of AAA patients, particularly men over 60 and smokers, may benefit from a one-time abdominal ultrasound. Discuss this with the team.
• Watch other arteries: popliteal, iliac and thoracic aneurysms are more common in this group and are checked during follow-up.

Older Adults, Younger Patients and Children

• Older and frail patients: most AAA patients are over 65. EVAR is often the preferred option here because it avoids a major abdominal incision. However, if life expectancy is short from cancer, dementia or advanced heart or lung failure, guidelines support a frank discussion about not operating at all. That is a legitimate, guideline-supported choice.
• Kidney function: contrast dye and X-ray exposure matter in older patients with reduced kidney function. Hydration protocols, contrast-minimising techniques and duplex-based follow-up instead of repeated CT can be used.
• Younger patients (under 60): open repair is often discussed seriously, because it is more durable over a 25?30 year horizon and avoids decades of imaging and reintervention.
• Connective tissue disorders such as Marfan or Ehlers-Danlos syndrome: stent grafts anchored in abnormal aortic tissue behave less predictably, and open repair is usually favoured. Genetic assessment and family screening are part of care.
• Children and adolescents: true degenerative AAA is essentially unknown in children. Paediatric aortic aneurysms are rare and usually related to genetic syndromes, vasculitis such as Takayasu disease, infection or previous trauma. These need a paediatric-cardiac and genetics-led plan, and are not treated with standard adult EVAR protocols.
• Women: smaller aortas and iliac arteries mean fewer women fit standard devices, and repair is advised at a smaller diameter. Individual anatomical assessment is essential.

If You Choose Not to Have the Procedure

Declining repair is your right, and for some patients it is the reasonable choice. You should understand what it means.

• The aneurysm will almost always continue to enlarge, slowly and silently, and the annual rupture risk rises steeply once the diameter passes roughly 6 cm.
• Rupture usually presents with sudden severe abdominal or back pain and collapse. Overall survival from rupture is poor, and emergency repair carries a far higher risk than planned repair.
• If you decline repair, you can still choose best medical management: strict blood pressure control, complete tobacco cessation, statin and antiplatelet therapy, and periodic ultrasound if you wish to keep monitoring.
• You can change your mind, but anatomy and fitness may worsen with time, and a case suitable for EVAR today may need open surgery later.
• For patients with very limited life expectancy, a documented conservative plan with symptom control and family counselling is a valid and compassionate pathway.

What Changes the Cost of EVAR

EVAR cost in India is dominated by the stent graft device rather than by hospital time. Apollo Hospitals Lucknow will give you a written, itemised estimate after your CT planning, because the device required is only known at that point. For current figures, please speak to the reception or the insurance and billing desk.

Insurance and Cashless Treatment in India

• Cashless route: for planned EVAR, the hospital's insurance desk raises pre-authorisation with your insurer or TPA. Allow several working days; complex or high-value device approvals can take longer or come back with a partial sanction.
• Reimbursement route: you pay and claim later. Keep the discharge summary, itemised final bill, all investigation reports, implant sticker or invoice for the stent graft, and payment receipts.
• Waiting periods: most Indian indemnity policies carry an initial 30-day waiting period and a 2?4 year waiting period for specified or pre-existing conditions. An aneurysm diagnosed before the policy started may be treated as pre-existing. Check your policy schedule and the specific exclusions list.
• Planned versus accident cover: an aneurysm is a disease, not an accident, so personal accident policies generally do not cover it. Traumatic aortic injury after a road accident may be handled differently. Emergency admission for rupture still requires intimation to the insurer, usually within 24 hours.
• Implant and device caps: many policies cap implant reimbursement or apply proportionate deduction if your room category exceeds the eligible limit. Because the stent graft is the largest single item, this materially affects your out-of-pocket amount. Confirm implant coverage in writing before admission.
• Government and corporate schemes: coverage under Ayushman Bharat PM-JAY, CGHS, ECHS, state schemes, railway or PSU panels varies by empanelment and by procedure package. Ask the insurance desk whether your specific scheme is applicable at Apollo Hospitals Lucknow for this procedure.
• Follow-up imaging after discharge is often an outpatient expense and may not be covered. Budget for it.

Planning Your Admission and What to Bring

• Photo ID and address proof for the patient and the main attendant, insurance card or policy copy, TPA approval letter and employer or scheme letters.
• All previous CT scans and ultrasound reports on CD or in original film form, earlier discharge summaries, ECG and echo reports.
• A written list of all current medicines with doses, including Ayurvedic, homeopathic and over-the-counter supplements. Some herbal products affect bleeding.
• Loose comfortable clothing, front-open shirts or kurtas, non-slip slippers, toiletries, and a shawl or blanket for the air-conditioned ward.
• Spectacles, hearing aid, denture case, walking stick or walker if used.
• Mobile phone with charger and a long cable, and a written list of family contact numbers.
• Arrange one attendant for the hospital stay and, ideally, a rota of two or three family members for the first two weeks at home. In joint families, decide in advance who handles medicines, who handles wound checks and who accompanies the patient to follow-up, so instructions are not lost between people.
• At home before discharge: shift sleeping to a bed rather than a floor mattress, keep a commode chair or Western toilet available, remove loose rugs and dark corridors, and keep a chair in the bathroom.
• Do not stop or restart blood thinners on your own. Follow only the written instruction given at discharge.

Warning Signs That Need Immediate Review

Go to the emergency department, or call the hospital at once, if you develop any of the following after EVAR:

• Sudden severe abdominal, flank or back pain, or pain with fainting, sweating or collapse.
• A swelling in the groin that is expanding, pulsating, hard or intensely painful, or fresh bleeding from the puncture site.
• A cold, pale, numb or painful leg or foot, or new inability to move the foot.
• Fever above 38?C persisting beyond a few days, chills, or pus or foul discharge from a groin wound.
• Passing very little urine, or dark urine, over 12?24 hours.
• New severe abdominal pain with bloody diarrhoea, which can indicate reduced bowel blood supply.
• New weakness, numbness or difficulty passing urine after a thoracic stent graft.
• Breathlessness at rest, chest pain, or palpitations.

A mild fever with malaise in the first few days after EVAR can be a self-limiting post-implantation reaction, but it still needs to be reported and assessed rather than assumed.

For Patients Travelling from Nearby Districts and Cities

Apollo Hospitals Lucknow receives aortic patients from across central and eastern Uttar Pradesh and neighbouring states ? including Kanpur, Unnao, Barabanki, Sitapur, Hardoi, Rae Bareli, Sultanpur, Amethi, Ayodhya, Basti, Gonda, Bahraich, Balrampur, Shravasti, Lakhimpur Kheri, Pratapgarh, Jaunpur, Azamgarh, Gorakhpur, Varanasi, Prayagraj, Bareilly and Moradabad, as well as from parts of Bihar, Uttarakhand and Nepal.

Practical suggestions

• Send your reports ahead. Share the CT aortogram and prior reports before travelling so the team can advise whether EVAR is likely feasible, avoiding a wasted journey.
• Plan two visits, not one. A first visit for consultation and CT planning, then a second for admission after the device is arranged and insurance is approved.
• Allow a buffer. Budget 5?7 days in Lucknow around a planned EVAR admission, longer if you have kidney or heart issues.
• Arrange accommodation for one or two attendants near the hospital. Ask the front desk for guidance on nearby options.
• Travel home carefully. Avoid long unbroken road journeys for the first 2 weeks; stop every hour to stretch. Air travel after EVAR is usually permitted once you are stable and reviewed, but confirm with your surgeon before booking.
• Plan follow-up realistically. Lifelong surveillance means periodic travel. Discuss which scans can be done locally and reviewed remotely, and which must be done at Apollo Lucknow.
• Suspected rupture is not a case for travel planning. Go to the nearest hospital with CT and surgical facilities immediately; transfer can follow once you are stabilised.

Contact and Appointments

Please confirm consultant availability, clinic days and current charges directly with the hospital reception, as these change from time to time.

Frequently Asked Questions

What are the risks associated with the EVAR procedure?

While EVAR is generally safe, potential risks include bleeding, groin wound problems, infection and anaesthesia-related complications. There is also a risk of endoleak, where blood continues to flow into the aneurysm sac, and less commonly graft migration, limb blockage or kidney strain from contrast dye. Our team at Apollo Hospitals Lucknow will discuss these risks in relation to your specific anatomy during your consultation.

How long does the EVAR procedure take?

The procedure typically takes about 1 to 3 hours, depending on complexity. Patients usually stay in hospital for 1 to 3 day