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Endovascular Aneurysm Repair (EVAR) of Abdominal Aortic Aneurysm (AAA)
- Operator: Seung-Whan Lee, MD
Case Presentation
A 76-year-old male was admitted to our hospital for the management of progressively enlarging infrarenal abdominal aortic aneurysm (AAA). 9 years ago, his AAA was initially detected on abdominal CT scan while he was evaluated for gastric cancer. 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 4.6 cm to 5.7 cm for 1 year. He had history of gastric cancer, asthma, stroke, 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 both common iliac arteries (Figure 1, Figure 2).
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 Excluder Stent Graft System 23-12mm/140 mm from AAA to right common iliac artery ( Movie 2, Figure 3). An Excluder Contralateral limb (16-20mm/135 mm) was deployed at left common iliac artery (Figure 4) and an Excluder Contralateral limb (16-20mm/95mm) was deployed at right common iliac artery ( Movie 3, Figure 5). The balloon dilatation was performed via left and right femoral artery with a Tri-lobe balloon 34mm balloon at stent body and both bifurcated branches (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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