EVAR---WHAT WE NEED TO

KNOW BEFORE WE START

Jia Xin, Guo Wei, Liu XP,

Yin Tai, Xiong Jiang

www.vasc.cn

• EVAR EndoVascular Aortic Repair

• EVR EndoVascular Repair

• SG Stent-Graft

• TEVAR Thoracic EndoVascular Aortic Repair

• PTA Percutaneous transluminal angioplasty

SHAPE

Renal A

Lumbar A

Mesentery A

Iliac A

Collaterals

ETIOLOGY

Atherosclerosis

Inherent

Autoimmunity

Infection

Trauma

Others

High Risk

Age>65 y

Gender: M > F (4:1)

Family (1° M): 20%

SMOKING: > 10 y

Peripheral Aneurysm

femoral, popliteal, thoracic Hypertension

Diabetic negative

Race

Clinical Manifestations

M/F 5 ： 1（＞ 60y ）

Infrarenal AAA 90%,

Extending to Iliac 66%

Pain; AVF ;Embolism

Pulse Mass

DIAGNOSIS

• Duplex-US

• CTA

• MRA

• DSA

• IVUS

• X- ray

INDICATION

• DIAMETER

• EXPANSION

RATE

• SYMPTOM

• Shape， Age， Life expectancy, Comorbidity

• DIAMETER AND RUPTURE

1 yr rupture risk :

4 - 4.9cm 1.1%

5 - 5.9cm 3.3%

6 - 6.9cm 9.4%

7 - 7.9cm 24% Law et al 1994

5 yr rupture risk:

4cm 5 - 13%

5cm 25 - 38% Vardulaki 1998

OR RESULTS

Mortality

• Best modern individual series 3.5%

• State/community 10.3%

• High risk patients 7.0%

• Patients>80years 10.0%

• High+extra-anatomic bypass 16.0%

Peri-Op Complications

--MI 2%-8%

--All pulmonary 8%-12%

--Reduced renal function 5%-12%

--Dialysis 1%-6%

70% 5 years survival for elective AAA repair

JUAN PARODI

INSTITUTO

CARDIOVASCULAR

DE BUENOS AIRES

ARGENTINA

FIRST HUMAN ELG1989

EVAR History

我国 EVAR的历史 1992年 医院专家开始关注 EVAR国际发展动向

1994年 医院成立 EVAR技术攻关协作组

1995年 协作组前往阿根廷、美国、英国等参观访问

1996年 规划军队九五攻关重点课题

1997年 临床应用 Vanguard腔内治疗 AAA取得成功

1998年 首例 Talent治疗胸主动脉瘤

首例 Talent胸腹主动脉瘤的杂交手术

首例 Talent治疗主动脉夹层

1999年 完成重大医疗保健任务

At least 80At least 80 international conference international conference

with EVAR symposium in the past with EVAR symposium in the past

decadedecade

Important magzines and index

EVAR as first choice in many

centers

Endovascular

Open Surgical

Advantage

Indication for EVAR

Same to OR generally

Anatomy requirements

Landing zone; Access

Proximal

Distal

Access

Anatomy Requirements

• Suitable access (diameter at least 7mm) .

• Proximal landing >15mm ；distal >20mm.

• Angulation <45 - <60°

Pre-OP Assessment

• Measurement:

• Cross section

• MIP

• 3D VR

• Sizing protocol

Proximal

Distal

Collateral

Access

1

2

3

4

Key Points

• Diameter—Cross section

• Length– VR or MIP

• Catheter with marker

Proximal landing zone

• Anatomy – Diameter

– Length

– Morphology

– Angulation

– Thrombus

– Calcification

Each one can affect the final decision

Proximal Neck

• Measure at different

levels

• Spot accessary renal

artery

Taper Neck

• Maximal diameter

+10%

Diameter

measurement a

b

• outer-outer

membrane

• (a+b) / 2

•11•22•33

•nn

length=NX

Layer thickness

Length Assessment

Measure with marker

catheter

• Proximal neck

– length(?)

– angulation(?)

Distal Landing

• Aorta bifurcation

Diameter>20mm

Otherwise, AUI

• Iliac artery

– CIA length, diameter

– Angulation and

calcification

– EIA IIA

CIA

Measure diameter and

length

– Landing length>20mm

– Cover as long as

possible(to prevent

late aneurysm)

• When aneurysm involve CIA

– EIA as landing zone

– IIA

• Embolizaion

• 40% buttock claudication

• Erectile dysfunction

EIA

• Angulation

• Calcification

• Diameter at least 7mm

• Mainbody through the bigger

and straighter side( C

curve better than S curve)

Choose SG

• Neck diameter

• SG diameter=neck diameter + 10-20%

注意 :

• If diameter between two references,

choose the bigger

• If length between two references, choose

the smaller

Pre-OP Protocol

◊ General picture (aneurysm and landing zone)

◊ Choose access； C cuve> S

curve ( 20/22/24F) ◊ familiar with SG

● plan A and B ◊ For small access, female,

prepare CIA conduit

ENDOLEAK

Post-EVAR

Plan：3 、 6 、 12month、 every year

Duplex-US 、 CT、 DSA、 MR

Clinic consultant

Follow UP

THANKS

www.vasc.cn