Martin MalinaDirector EVAR

Is EVAR Appropriate???

How?

EVAR

Seoul***:

41 %***Sang Dong Kim et al, 2012

Copenhagen*:

35 %

*Shahidi S et al, 2009

57 % (≥75 yrs)

Mortality of OR in rAAA

Medicare**:

38 % - 56 % (depending on hospital volume)

**Egorova N et al, 2009

rAAA

100 %

50 %

1990 2000 2010

35%

Year

>90%

eEVARMortality *

*Holst J et al, 2006

rAAA

1990 2000 2010

35%

Year

eEVARMortality

>90%

rAAA Survivors

(n)

More rAAA´s Offered Tx!

Pts ”Unsuitable for EVAR” Benefit the Most!

Tips for Juxtarenal rAAA

Type of SG

Standard SG?!

eEVAR Outcome in No Neck

Type of SG

Standard Fenestrated Branched Chimneys

Not available for sale.

Off-the Shelf

P-Branch

Top Cap

Top Cap

Top Cap

eEVAR in Juxtarenal rAAA Conclusion

Outcome Is Worse

All rAAA Can Be Treated with eEVAR

(Obviously!)

More Pts Get Treated

Overall Improved rAAA Survival

Probably Better than OR

eEVAR in Juxtarenal rAAA Conclusion

Consider a Standard SG!

The Worst Candidates Benefit Most!

ChEVAR +/- Occlusion Balloon for

the Truly Unstable Pts

Fenestrated and Branched Off-the-Shelf

The ShardLondon

Turning TorsoMalmö