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CC BY-NC-ND 4.0 · The Arab Journal of Interventional Radiology 2022; 06(01): 015-020
DOI: 10.1055/s-0042-1750105
Review Article

Endovascular Aortic Aneurysm Repair: A Narrative Review

Zia Ur Rehman
1   Division of Vascular Surgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
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Abstract

Endovascular aortic aneurysm repair (EVAR) has evolved as minimally invasive method of treating infrarenal abdominal aortic aneurysms (AAA) with perioperatively mortality of less than 1% compared with 5% with open AAA repair as suggested by many randomized control trials. Computed tomography angiography is the imaging of choice for appropriate selection of a patient with EVAR. For patients with unsuitable anatomy, advanced EVARs techniques, such as fenestrated, branch, and chimney EVARs, are also increasingly being offered to patients with equal success. Patients with ruptured AAA are treated with this minimally invasive procedure. Percutaneous EVAR emerged with less of wound-related complications. Endoleaks are the most common complications peculiar to this procedure, and most are preventable by preoperative planning. They are detected on completion angiogram or on the surveillance imaging. This review discusses indications of EVAR, its selection criteria, procedural steps, and common complications associated with this procedure and advanced EVARs.

Keywords

abdominal aortic aneurysm - stent-graft - complex aortic aneurysms - EVAR - endovascular aneurysm repair


Publication History

Article published online:
21 June 2022

© 2022. The Pan Arab Interventional Radiology Society. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Kim HO, Yim NY, Kim JK, Kang YJ, Lee BC. Endovascular aneurysm repair for abdominal aortic aneurysm: a comprehensive review. Korean J Radiol 2019; 20 (08) 1247-1265
    CrossrefPubMedGoogle Scholar
  • 2 Ullery BW, Hallett RL, Fleischmann D. Epidemiology and contemporary management of abdominal aortic aneurysms. Abdom Radiol (NY) 2018; 43 (05) 1032-1043
    CrossrefPubMedGoogle Scholar
  • 3 Lederle FA, Wilson SE, Johnson GR. et al; Aneurysm Detection and Management Veterans Affairs Cooperative Study Group. Immediate repair compared with surveillance of small abdominal aortic aneurysms. N Engl J Med 2002; 346 (19) 1437-1444
    CrossrefPubMedGoogle Scholar
  • 4 Chaikof EL, Dalman RL, Eskandari MK. et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg 2018; 67 (01) 2-77.e2
    CrossrefPubMedGoogle Scholar
  • 5 Kent KC. Endovascular aneurysm repair–is it durable?. N Engl J Med 2010; 362 (20) 1930-1931
    CrossrefPubMedGoogle Scholar
  • 6 Li W, Rongthong S, Prabhakar AM, Hedgire S. Postoperative imaging of the aorta. Cardiovasc Diagn Ther 2018; 8 (Suppl. 01) S45-S60
    CrossrefPubMedGoogle Scholar
  • 7 Bryce Y, Rogoff P, Romanelli D, Reichle R. Endovascular repair of abdominal aortic aneurysms: vascular anatomy, device selection, procedure, and procedure-specific complications. Radiographics 2015; 35 (02) 593-615
    CrossrefPubMedGoogle Scholar
  • 8 Manunga JM, Cragg A, Garberich R. et al. Preoperative inferior mesenteric artery embolization: a valid method to reduce the rate of type II endoleak after EVAR?. Ann Vasc Surg 2017; 39: 40-47
    CrossrefPubMedGoogle Scholar
  • 9 Sikkink CJ, Reijnen MM, Zeebregts CJ. The creation of the optimal dedicated endovascular suite. Eur J Vasc Endovasc Surg 2008; 35 (02) 198-204
    CrossrefPubMedGoogle Scholar
  • 10 Eliason JL, Guzman RJ, Passman MA, Naslund TC. Infected endovascular graft secondary to coil embolization of endoleak: a demonstration of the importance of operative sterility. Ann Vasc Surg 2002; 16 (05) 562-565
    CrossrefPubMedGoogle Scholar
  • 11 Ohki T, Veith FJ. Endovascular grafts and other image-guided catheter-based adjuncts to improve the treatment of ruptured aortoiliac aneurysms. Ann Surg 2000; 232 (04) 466-479
    CrossrefPubMedGoogle Scholar
  • 12 Mastracci TM, Garrido-Olivares L, Cinà CS, Clase CM. Endovascular repair of ruptured abdominal aortic aneurysms: a systematic review and meta-analysis. J Vasc Surg 2008; 47 (01) 214-221
    CrossrefPubMedGoogle Scholar
  • 13 Powell JT, Sweeting MJ, Thompson MM. et al; IMPROVE Trial Investigators. Endovascular or open repair strategy for ruptured abdominal aortic aneurysm: 30 day outcomes from IMPROVE randomised trial. BMJ 2014; 348: f7661
    CrossrefPubMedGoogle Scholar
  • 14 Bidd H, Lyons O. EVAR: better off awake?. Eur J Vasc Endovasc Surg 2020; 59 (05) 739
    CrossrefPubMedGoogle Scholar
  • 15 Aburahma AF, Campbell JE, Mousa AY. et al. Clinical outcomes for hostile versus favorable aortic neck anatomy in endovascular aortic aneurysm repair using modular devices. J Vasc Surg 2011; 54 (01) 13-21
    CrossrefPubMedGoogle Scholar
  • 16 Asakura T. Recent development and long-term results of open vs EVAR for pararenal abdominal aortic aneurysms. Ann Vasc Dis 2018; 11 (04) 458-463
    CrossrefPubMedGoogle Scholar
  • 17 Alric P, Canaud L. Is chimney EVAR an acceptable endovascular technique?. EJVES Short Rep 2019; 42: 43
    CrossrefPubMedGoogle Scholar
  • 18 Lee JT, Greenberg JI, Dalman RL. Early experience with the snorkel technique for juxtarenal aneurysms. J Vasc Surg 2012; 55 (04) 935-946 , discussion 945–946
    CrossrefPubMedGoogle Scholar
  • 19 Donas KP, Lee JT, Lachat M, Torsello G, Veith FJ. PERICLES investigators. Collected world experience about the performance of the snorkel/chimney endovascular technique in the treatment of complex aortic pathologies: the PERICLES registry. Ann Surg 2015; 262 (03) 546-553 , discussion 552–553
    CrossrefPubMedGoogle Scholar
  • 20 Hongku K, Resch T, Sonesson B, Dias NV. Mid-term results of fenestrated and of branched aneurysm repair of previous failed Fenestrated EVAR. Ann Vasc Surg 2020; 67: 35-42.e1
    CrossrefPubMedGoogle Scholar
  • 21 Shahverdyan R, Gray D, Gawenda M, Brunkwall J. Single centre results of total endovascular repair of complex aortic aneurysms with custom made anaconda fenestrated stent grafts. Eur J Vasc Endovasc Surg 2016; 52 (04) 500-508
    CrossrefPubMedGoogle Scholar
  • 22 Vatakencherry G, Molloy C, Sheth N, Liao M, Lam CK. Percutaneous access planning, techniques and considerations for endovascular aortic repair (EVAR). Cardiovasc Diagn Ther 2018; 8 (Suppl. 01) S184-S190
    CrossrefPubMedGoogle Scholar
  • 23 Buck DB, Karthaus EG, Soden PA. et al. Percutaneous versus femoral cutdown access for endovascular aneurysm repair. J Vasc Surg 2015; 62 (01) 16-21
    CrossrefPubMedGoogle Scholar
  • 24 Nelson PR, Kracjer Z, Kansal N. et al. A multicenter, randomized, controlled trial of totally percutaneous access versus open femoral exposure for endovascular aortic aneurysm repair (the PEVAR trial). J Vasc Surg 2014; 59 (05) 1181-1193
    CrossrefPubMedGoogle Scholar
  • 25 Amin S, Schnabel J, Eldergash O, Chavan A. Endovascular aneurysm repair (EVAR): complication management [in German]. Radiologe 2018; 58 (09) 841-849
    PubMedGoogle Scholar
  • 26 Törnqvist P, Resch T. Endoleaks after EVAR and TEVAR: indications for treatment and techniques. J Cardiovasc Surg (Torino) 2014; 55 (2, Suppl 1): 105-114
    PubMedGoogle Scholar
  • 27 Karthikesalingam A, Cobb RJ, Khoury A. et al. The morphological applicability of a novel endovascular aneurysm sealing (EVAS) system (Nellix) in patients with abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 2013; 46 (04) 440-445
    CrossrefPubMedGoogle Scholar
  • 28 Mehta M, Paty PS, Roddy SP. et al. Treatment options for delayed AAA rupture following endovascular repair. J Vasc Surg 2011; 53 (01) 14-20
    CrossrefPubMedGoogle Scholar