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Endovascular Aneurysm Repair (EVAR) of Abdominal Aortic Aneurysm (AAA)
- Operator: Seung-Whan Lee, MD
Case Presentation
A 70-year-old female was referred to our hospital for the management of slowly enlarging infrarenal abdominal aortic aneurysm (AAA). Her AAA was initially detected at the local hospital about 3 years ago and the increase of the aneurysmal diameter was found incidentally by computed tomography (CT) performed as preoperative work-up for the orthopedic surgery. On the last CT scan, maximal aneurysmal diameter has been increased from 5.2 cm to 5.8 cm for the past 3 years. He had history of hypertension and ischemic heart disease.
Baseline Computed Tomography of the Abdominal Aorta
CT showed an abdominal aortic aneurysm with mural thrombi from infrarenal level to both common iliac arteries (Figure 1, Figure 2).
Procedure
Both femoral arteries were punctured with 8 Fr sheath and aortography was done via right femoral artery using a 5 Fr pigtail diagnostic catheter ( Movie 1). After removal of the left femoral artery 8 Fr sheath, two 8 Fr Proglide devices were placed into the left puncture site. We dilated the left femoral artery using 18 Fr sheath dilator and then inserted and deployed the Endurant Stent Graft System 18 Fr (23-16-12mm/145mm bifurcated stent graft system) ( Movie 2, Figure 3). An Endurant stent graft system limb 16Fr (20-16mm/82mm) was deployed at right common iliac artery (Figure 4, Movie 3). The balloon dilatation was done via left femoral artery with a Reliant 46-100 mm balloon at stent body and both bifurcated branches (Figure 5, Figure 6, Figure 7, Figure 8). 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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