Vascular

Endovascular Aortic Aneurysm Repair (EVAR)

OPERATION: Endovascular Repair of Abdominal Aortic Aneurysm (EVAR)
ANAESTHETIC: General / regional / local anaesthesia with sedation
ANTIBIOTICS: IV antibiotics at induction
POSITION: Supine. Both groins prepared. Image intensifier available.

INDICATION:
Infra-renal AAA [size] cm. CT angiography confirming suitable anatomy: proximal neck ≥1.5 cm, angulation <60°, no significant neck thrombus or calcification, iliac vessels ≥6 mm diameter. [Branched/fenestrated device for juxta-renal / suprarenal extension].

PROCEDURE:
WHO Checklist performed. Bilateral groin incisions. Common femoral arteries exposed and vascular slings applied. Seldinger access bilaterally. 7F sheaths inserted bilaterally. Additional 5F catheter left groin for completion angiography.

DEPLOYMENT (Cook Zenith / alternative device):
Stiff Lunderquist wire placed in thoracic aorta via right groin. Main body deployed over wire — gold markers positioned below renal arteries. Main body deployed; contralateral limb gate opened. Glide wire passed into contralateral limb via left groin and exchanged for stiff wire. Contralateral limb deployed with 1-1.5 segment overlap into main body. Iliac angiography confirmed left internal iliac patency. Bare metal proximal segment released; nose cone retrieved. Completion angiogram — renal vessels patent. Ipsilateral limb deployed via right groin with adequate overlap; right internal iliac confirmed patent. Completion angiogram — [no endoleak / type 1/2/3 endoleak — managed as below].