Radiology of advanced EVAR techniques in complex abdominal aortic aneurysms


Advanced Endovascular Aortic Repair (EVAR) refers to devices and techniques used for endografting of aortic aneurysms that are considered anatomically unsuitable for conventional EVAR. Customised devices and modified use of conventional EVAR devices now overcome challenging landing zones. Fenestrated and branch devices, together with chimney and periscope techniques can be used to overcome proximal landing zone challenges, while iliac branch grafts and sandwich techniques have been used to address challenging distal iliac landing issues. Due to the novelty of these techniques, life-long surveillance is crucial, with CT Aortography (CTA) being the key investigation. Currently, the body of literature surrounding the imaging aspects of these techniques is scarce. The purpose of this imaging review is to illustrate the appearance of advanced EVAR in both routine surveillance and complicated cases, using conventional and novel CTA techniques.

Key Points

This review updates readers about advanced endovascular repair of abdominal aortic aneurysms

It illustrates the common CT appearances following advanced EVAR

Novel CTA techniques in troubleshooting problems unique to advanced EVAR are described

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Correspondence to Uei Pua.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Multiplanar movie loop of Fig. 10, showing left renal fenestration endoleak. (WMV 294 kb)

Volumetric movie loop of Fig. 11, showing right renal fenestration endoleak. (WMV 224 kb)

Movie 1

Multiplanar movie loop of Fig. 10, showing left renal fenestration endoleak. (WMV 294 kb)

Movie 2

Volumetric movie loop of Fig. 11, showing right renal fenestration endoleak. (WMV 224 kb)

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Pua, U., Tan, K. Radiology of advanced EVAR techniques in complex abdominal aortic aneurysms. Eur Radiol 22, 387–397 (2012) doi:10.1007/s00330-011-2261-9

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  • Aortic aneurysm
  • Endograft
  • Fenestrated
  • Branch
  • Chimney