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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."
Endovascular coiling is an endovascular treatment for intracranial aneurysms and bleeding throughout the body. The procedure reduces blood circulation to an aneurysm or blood vessel through the implantation of detachable platinum wires, with the clinician inserting one or more into the blood vessel or aneurysm until it is determined that blood flow is no longer occurring within the space.
A flow diverter is an endovascular prosthesis used to treat intracranial aneurysms. [1] It is placed in the aneurysm's parent artery, covering the neck, in order to divert blood flow and determine a progressive thrombosis of the sac. [2]
Endovascular and endovenous procedures (e.g., EVAR) can now form the bulk of a vascular surgeon's practice. The treatment of the aorta, the body's largest artery, dates back to Greek surgeon Antyllus, who first performed surgeries for various aneurysms in the second century AD.
The treatment options for asymptomatic AAA are conservative management, surveillance with a view to eventual repair, and immediate repair. Two modes of repair are available for an AAA: open aneurysm repair, and endovascular 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]
Surgery (open or endovascular) is the definitive treatment of an aortic aneurysm. Medical therapy is typically reserved for smaller aneurysms or for elderly, frail patients where the risks of surgical repair exceed the risks of non-operative therapy (observation alone).
Symptoms of an unruptured aneurysm are often minimal, but a ruptured aneurysm can cause severe headaches, nausea, vision impairment, and loss of consciousness, leading to a subarachnoid hemorrhage. Treatment options include surgical clipping and endovascular coiling, both aimed at preventing further bleeding.
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