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Endovascular aneurysm repair (EVAR) is a type of minimally-invasive endovascular surgery used to treat pathology of the aorta, most commonly an abdominal aortic aneurysm (AAA). When used to treat thoracic aortic disease, the procedure is then specifically termed TEVAR for "thoracic endovascular aortic/aneurysm repair."
Prior to the advent of endovascular aneurysm repair (EVAR), OAS was the only surgical treatment available for aortic aneurysms. The shift away from open aortic surgery towards endovascular surgery since 2003 has been driven by worse perioperative mortality associated with OAS, particularly in patients in relatively frail health. [2]
Two modes of repair are available for an AAA: open aneurysm repair, and endovascular aneurysm repair . An intervention is often recommended if the aneurysm grows more than 1 cm per year or it is bigger than 5.5 cm. [52] Repair is also indicated for symptomatic aneurysms. Ten years after open AAA repair, the overall survival rate was 59%. [53]
According to a review of global data through 2019, the prevalence of abdominal aortic aneurysm worldwide was about 0.9% in people under age 79 years, and is about four times higher in men than in women at any age. [4] Death occurs in about 55-64% of people having rupture of the AAA. [4] Screening with ultrasound is indicated in those at high risk.
In 2000, Diethrich performed the first endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysm. Dietrich trained several future leaders in the field of endovascular surgery at the Arizona Heart Hospital including Venkatesh Ramaiah, MD [3] who succeeded him as medical director of the institution in 2010. [4]
Khoynezhad A., et al. "Results of a multicenter, prospective trial of thoracic endovascular aortic repair for blunt thoracic aortic injury (RESCUE trial)." Journal of Vascular Surgery (2013). Lo, Ruby C., et al. "Gender differences in abdominal aortic aneurysm presentation, repair, and mortality in the Vascular Study Group of New England."
Endovascular repair is the current gold standard due to increased success rates and lower complications. [9] [1] Patients that are able to undergo endovascular repair without contraindications should proceed with it. [1] Repair should be delayed if there is life-threatening intra-abdominal or intracranial bleeding or if the patient is at risk ...
The Bentall procedure is a type of cardiac surgery involving composite graft replacement of the aortic valve, aortic root, and ascending aorta, with re-implantation of the coronary arteries into the graft.