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Endovascular Aneurysm Repair (EVAR) of Abdominal Aortic Aneurysm (AAA)
- Operator: Seung-Whan Lee, MD
Case Presentation
An 55-year-old male was referred to our hospital for the management of progressively enlarging infrarenal abdominal aortic aneurysm (AAA). His AAA was initially detected after general health check-up about 2 years ago and the increase in the aneurysmal diameter was found by regular follow-up using computed tomography (CT). On the last CT scan, maximal aneurysmal diameter had been increased from 4.9 cm to 5.6 cm for 1 year. He was ex-smoker and had history of ischemic heart disease.
Baseline Computed Tomography of the Abdominal Aorta
CT showed an abdominal aortic aneurysm with mural thrombi, the extent of which was from 28.7mm distal to right renal artery to aortic bifurcation (Figure 1, Figure 2).
Procedure
Both femoral arteries were punctured with 8 Fr sheath, both of which were replaced with two 8 Fr Proglide devices and aortography was done via right femoral artery using a 5 Fr pigtail diagnostic catheter ( Movie 1). We dilated the left femoral artery using 14 Fr sheath dilator and then inserted and deployed the Endurant Stent Graft System 20 Fr (28-16-14mm/170mm bifurcated stent graft system) ( Movie 2, Figure 3). An Endurant stent graft system limb 14Fr (16-13mm/120mm) was deployed at right common iliac artery ( Movie 3). The balloon dilatation was done via left and right femoral artery with a Reliant 46mm balloon at stent body and both bifurcated branches (Figure 4, Figure 5, Figure 6, Figure 7). Final angiogram showed successful exclusion of AAA without significant endoleak ( Movie 4). After the intervention, both puncture sites were sutured by two prepared Proglides at each site.
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