Endovascular Treatment of Abdominal Aortic Aneurysm

Hyo-Cheol Kim

doi:10.7599/hmr.2011.31.1.1

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Kim: Endovascular Treatment of Abdominal Aortic Aneurysm

Review Article

Hanyang Medical Reviews

Hanyang Medical Reviews 2011; 31(1): 1-9.

Published online: 28 February 2011

DOI: https://doi.org/10.7599/hmr.2011.31.1.1

Endovascular Treatment of Abdominal Aortic Aneurysm

Hyo-Cheol Kim, M.D.

Department of Radiology, Seoul National University Hospital, Seoul, Korea.

Corresponding author (angiointervention@gmail.com)

Received 6 November 2010 Accepted 27 December 2011

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Endovascular aneurysm repair (EVAR) has been a revolutionary development in the treatment of abdominal aortic aneurysms (AAAs) since its introduction in the early 1990s. The result of the two randomized controlled trials comparing EVAR versus open repair for the treatment of AAAs has provided some insight to the advantages and limitations of EVAR technology. Endoleaks continue to be a challenge for EVAR and most endoleaks can now be successfully managed by endovascular techniques. Fenestrated and branched stent-graft technology is increasingly applied to patients with complex AAA anatomies. This paper outlines some of the concepts and discusses the controversies and challenges facing clinicians involved in EVAR today and in the future.

Keywords: Endovascular aneurysm repair, Stent-graft, Abdominal aortic aneurysm

Figures and Tables

Fig. 1

A 74-year-old man with abdominal aortic aneurysm. A) CT angiography with maximal intensity projection shows an infrarenal abdominal aortic aneurysm. B) Aortography after endovascular aneurysm repair shows exclusion of abdominal aortic aneurysm.

Fig. 2

A 63-year-old man with abdominal aortic aneurysm. A) CT angiography with maximal intensity projection shows an infrarenal abdominal aneurysm with wall calcification (arrowhead). Note two left renal arteries. B) Aortography after stent-graft deployment shows type I endoleak (arrowhead). C) Spot image obtained after deployment of proximal extender cuff (arrow). Left lower renal artery (arrowhead) was embolized by using multiple coils to prevent type II endoleak before deployment of extender cuff. D) Aortography after deployment of extender cuff reveals disappearance of type I endoleak.

Fig. 3

A 54-year-old man who received endovascular aneurysm repair for abdominal aortic aneurysm. A) Axial CT image of arterial phase shows small enhancing lesion (arrow) within abdominal aortic aneurysm suggesting type II endoleak. B) Right internal iliac angiography shows small sac filled with contrast media which is supplied by the iliolumbar artery (white arrowhead) connected with the lumbar artery (black arrowhead). C) Spot image obtained during the procedure of embolization shows coils (arrow) within the sac. Microcatheter (arrowhead) within the lumbar artery is noted. D) Axial CT iamge of arterial phase shows coils within endoleak sac.

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