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Endovascular Aneurysm Repair
- Operator: Seung-Whan Lee, MD
Case Presentation
An 80 years old male patient was referred to cardiology department for the evaluation of abdominal aortic aneurysm that was found incidentally by CT angiogram. He had hypertension, dyslipidemia and received coronary artery bypass surgery 15 years before. The patient has no abdominal or lower extremity symptoms.
CT Findings
  1. Infrarenal fusiform abdominal aortic aneurysm was identified from 5cm below of renal artery orifice to aortic bifurcation. The length was 6.5 cm and the maximal diameter was 4.8 cm. Partial thrombus was seen along the aneurysmal wall of aorta and there was diffuse atherosclerotic change in thoracoabdominal aorta.
Procedure
Both femoral artery was accessed by 7 Fr sheaths. After taking abdominal aortogram, we first occluded Lt internal iliac artery with Amplatzer Vascular Plug II (10mm) to avoid perigraft leakage. (Figure 1) The next step was to advance Endologix introducer system via Lt femoral artery up to abdominal aneurysm site. ( Movie 1) Then EN snare was inserted via Rt femoral artery to capture the system wire. ( Movie 2) We deployed Endologix (28mm, 70mm, 30mm, 16mm bifurcated body) to the aneurysmal site and dilated the graft with Reliant balloon 46mm. ( Movie 3, Movie 4) Another Endologix graft (20mm, 100mm, 34mm) was inserted to the upper portion of abdominal aneurysm next to the bifurcated body graft. ( Movie 5) Finally, we deployed Endologix (20mm, 70mm, 13mm) at the Lt common iliac artery to bifurcated graft body. (Figure 2) Rt and Lt femoral artery were closed by Mynx and Proglide devices respectively. The EVAR procedure was successfully done. ( Movie 6)
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