11. Endovascular Aneurysm Repair
• In 1991, Jaun C. Parodi published his seminal work on using a
homemade tube endograft to treat AAA
• 1999, the 1st commercially available device
• Treatment of abdominal aortic aneurysm (AAA) with a device
composed of a Dacron graft and a balloon expandable stent
Comprehensive Vascular and Endovascular Surgery
12. Open Repair EVAR
Complication Invasive Surgery Less Invasive
Bloodloss More than EVAR Less
Recovery time More than EVAR Shorter
Surveillance Less than EVAR Lifelong Surveillance
Re-intervention Rates Less More than Open Surgery
Benefit of Endovascular Treatment
Comprehensive Vascular and Endovascular Surgery
14. Annualized Risk of Rupture of AAA Based on Size
Description Diameter of
Aorta(cm)
Estimated Annual
Risk of Rupture
(%)
Estimated 5-y
Risk of Rupture
(%)
Normal
aorta
3-3.9 0.3 0 (unless AAA
develops)
Small AAA 4-4.9 0.5-1.5 5-10
Moderate
AAA
5-5.9 1-11 30-40
Large AAA 6-6.9 11-22 > 50
Very large
AAA
> 7 > 30 Approaching 100
Ruttherford Vascular Surgery 8th ed
15.
16.
17.
18.
19. Indication for Sx / EVAR
• Male size > 5.5 cm
• Female > 5 cm
• Growth rate > 1 cm/yr
>0.5 cm/6mo
>0.25cm/3mo
• Symptoms (Severe back pain ,Abdominal pain ,Hypotension)
• Saccular Aneurysm
• Complication (rAAA/Fistula/Distal embolization)
Ruttherford Vascular Surgery 8th ed
24. F 81 yrs,Infrarenal AAA 6.3 cm
Point of concern
-Extream age
-Angulated aortic neck
-Narrow aortic bifurcation
-Multiple co-morbidity
-High risk for GA
1st Elective EVAR in AYH (Oct 2019)
Prefer EVAR
69. My Experience in AYH
Type of
Surgery
EVAR TEVAR Results
Elective (5) EVAR (3)
EVAR convert OSA (1)
EVAR c IIA
embolization (1)
- D/C (5)
Emergency
(3)
Rupture AAA (1)
EVAR c AUI
Rupture TAAA c IMH (2)
TEVAR
Death (3)
