Vascular

Abdominal Aortic Aneurysm Repair (Endovascular) (EVAR)

ABDOMINAL AORTIC ANEURYSM REPAIR (ENDOVASCULAR) (EVAR)

Indication: AAA meeting size criteria for repair with suitable anatomy for endovascular repair: adequate infrarenal neck length (≥10–15 mm), neck angulation acceptable, iliac access vessels adequate, and no significant thrombus in the landing zones. EVAR associated with lower perioperative mortality than open repair (~1.5% vs ~3%).

Patient Position: Supine on a radiolucent table. Bilateral groin access. C-arm image intensifier available.

Anaesthesia: General, regional, or local with sedation.

Procedure:
1. Bilateral femoral arteries exposed via groin incisions (or percutaneous puncture with large-bore Perclose closure devices if anatomy permits).
2. Bilateral femoral arteriotomies made. Guide wires and sheaths advanced under fluoroscopic guidance to the abdominal aorta.
3. Aortogram performed to confirm aneurysm extent, renal artery levels, and iliac anatomy.