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Endovascular Aneurysm Repair (EVAR) of Abdominal Aortic Aneurysm (AAA)
- Operator: Seung-Whan Lee, MD
Case Presentation
A 69-year-old male was admitted to our hospital for the management of symptomatic infrarenal abdominal aortic aneurysm (AAA). 1 year ago, his AAA was initially detected on abdominal CT scan while he was evaluated for lumbar pain. He underwent lumbar pain 2 weeks ago. The increase in the aneurysmal diameter was found by follow-up using computed tomography (CT). On the last CT scan, maximal aneurysmal diameter increased from 4.7 cm to 5.0 cm for 1 year.
Baseline Computed Tomography of the Abdominal Aorta
CT showed an abdominal aortic aneurysm with mural thrombi, the extent of which was from 45mm distal to left renal artery to both common iliac arteries (Figure 1, Figure 2).
Procedure
Vascular accesses were obtained by insertion of two 7 Fr sheathes into both femoral arteries, and aortography was performed via right femoral artery using a 5 Fr pigtail diagnostic catheter ( Movie 1). We dilated the right femoral artery using 14 Fr and 18 Fr sheath dilator and then inserted and deployed the Endurant Stent Graft System 23-14-14mm/103 mm from AAA to right common iliac artery ( Movie 2, Figure 3). An Endurant Contralateral limb (16-10mm/93 mm) was deployed at left common iliac artery (Figure 4). We inserted two 14 Fr sheaths into both femoral arteries. Then, an Endurant Iliac Extension (16-13mm/93mm) was deployed at right common iliac artery ( Movie 3, Figure 5). The balloon dilatation was performed via left and right femoral artery with a Reliant balloon 46mm 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 manual compression.
Jae Hong Park2017-03-25
It is the standard EVAR procedure show case. thank for the reminding the EVAR case using Endurant graft system. Is it possible the operator closed puncture site by manual compression with routine method no matter how the procedure was used through femoral approach using 16 or 18 Fr sheath? I hope the possibility of that closing method.
Hanbit Park2017-03-27
Thank you for your comment. Preclosure preparation for puncture site using Proglide is standard technique for hemostasis after procedure. Rarely manual compression is inevitable due to difficulty of preclosure preparation which requires prolonged manual compression around 1 or 2 hours. So if possible closing for puncture site using Proglide is recommended.
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