J Korean Med Assoc.  2006 Jun;49(6):542-552. 10.5124/jkma.2006.49.6.542.

Endovascular Aneurysm Repair

• Hong KC
• Kim JY
• Jeon YS

• KMID: 2137834
• DOI: http://doi.org/10.5124/jkma.2006.49.6.542

Abstract

In recent years, the interest in minimally invasive surgery has grown, and the same trend is observed in vascular surgery and interventional radiology, leading to what is called endovascular surgery. Since the first use of a stent-graft for the endovascular exclusion of an abdominal aortic aneurysm (AAA), endovascular aneurysm repair (EVAR) has greatly expanded, and more than 50,000 devices have been implanted until now. The endovascular graft can be implanted from a remote access site in the groin with a less anesthetic requirement. The endovascular graft is advanced over guidewires up the femoral and iliac arteries. Once in position, the graft is deployed immediately distal from the renal arteries. The aorta is not clamped and the blood loss is less than with open surgery. EVAR for AAA offers an important new alternative to open surgical procedure. The mortality rates after EVAR are reported between 0~5%. Long-term follow-up reports are not available, but mid-term follow-up of EVAR reveals an incidence of re-intervention between 10~20% and a rate of late rupture of between 0.5~1.5% per year. The problems of endoleaks and graft failure continue to be the challenges that require technological innovations. Based on the currently available evidence, EVAR is an appropriate treatment for selected patients, especially those at high risk for open surgical repair.

Keyword

Abdominal aortic aneurysm; Stent; EVAR

MeSH Terms

Aneurysm*
Aorta
Aortic Aneurysm, Abdominal
Endoleak
Groin
Humans
Iliac Artery
Incidence
Inventions
Mortality
Radiology, Interventional
Renal Artery
Rupture
Stents
Surgical Procedures, Minimally Invasive
Transplants

Figure

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  Figure 1 Suggested positions of operation team members and equipment (Comprehensive review of vascular and endovascular surgery, 2004)

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  Figure 2 Several steps in the introduction of a stent-graft (Comprehensive review of vascular and endovascular surgery, 2004)

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  Figure 3 Classification of endoleak (Comprehensive review of vascular and endovascular surgery, 2004)

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