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Endovascular Aneurysm Repair (EVAR) of Abdominal Aortic Aneurysm (AAA)
- Operator: Seung-Whan Lee, MD
Case Presentation
An 59-year-old male was admitted to our hospital for the management of progressively enlarging infrarenal abdominal aortic aneurysm (AAA). 3 years ago, his AAA was initially detected after general health check-up 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 increased from 5.26 cm to 5.55 cm for 1 month. He was current smoker and had history of hypertension, diabetes, hyperlipidemia and 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 4cm distal to left renal artery to aortic bifurcation (Figure 1, Figure 2).
Procedure
Vascular accesses were obtained by insertion of two 8 Fr sheathes into both femoral arteries, and aortography was performed via right femoral artery using a 5 Fr pigtail diagnostic catheter ( Movie 1). After the puncture sites were prepared to be closed using 2 8Fr Proglide for each site, we dilated the right femoral artery using 18 Fr sheath dilator and then inserted and deployed the Endurant Stent Graft System 20 Fr (28-16-14mm/124mm bifurcated stent graft system) from AAA to right common iliac artery ( Movie 2, Figure 3). An Endurant stent graft system limb 14Fr (16-16mm/120mm) was deployed at left common iliac artery ( Movie 3). The balloon dilatation was performed 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 closed by two prepared Proglides.
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