Endovascular Abdominal Aortic Aneurysm Repair

  • Andrew England
  • Micheal Murphy
  • Richard G. McWilliams
Part of the Medical Radiology book series (MEDRAD)


Endovascular aortic aneurysm repair (EVAR) is a minimally-invasive alternative to open repair and offers lower early mortality rates, reduction in morbidity and post-procedural stay. Patient suitability for EVAR requires that the aortic morphology meets anatomical inclusion criteria. Short, excessively dilated, angulated and thrombus-lined aortic necks are associated with suboptimal outcomes. Although early mortality rates are favourable, EVAR is also associated with a higher incidence of follow-up complications and reinterventions compared to open surgery. Endoleaks form the bulk of these and if device-related increase the risk of aneurysm rupture. Graft migration, occlusion and structural disintegration have also been reported following EVAR. Even so, EVAR has now become the dominant treatment option for asymptomatic AAAs (≥ 5.5 cm in diameter) for patients deemed fit for surgery. Such is the enthusiasm for EVAR that studies have started to report on the efficacy of EVAR in small or ruptured AAAs. With the anatomical limitations of many EVAR devices there has been a drive to develop stent grafts which can extend the reach of EVAR. Fenestrated and branched stent grafts provide an alternative option for complex aortic aneurysms. Conventional infrarenal devices have also been redesigned to incorporate lower profile delivery systems and cover a wider range of aortic morphologies. Modern hybrid theatres are the ideal environment to implant these complex grafts. In many centres annual follow-up by contrast-enhanced CT has switched to a more cost-effective combination of ultrasound and abdominal radiography.


Iliac Artery Internal Iliac Artery Common Iliac Artery Adaptive Statistical Iterative Reconstruction Open Surgical Repair 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Andrew England
    • 1
  • Micheal Murphy
    • 2
  • Richard G. McWilliams
    • 3
  1. 1.Royal Liverpool University HospitalLiverpoolUK
  2. 2.Victoria University HospitalCorkIreland
  3. 3.Royal Liverpool & Broadgreen university HospitalsLiverpoolUK

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