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Endovascular Aneurysm Repair (EVAR), x-ray analysis

  • Arindam Chaudhuri
  • Digital Images
  • Online

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Credit: Endovascular Aneurysm Repair (EVAR), x-ray analysis. Arindam Chaudhuri. Attribution 4.0 International (CC BY 4.0)

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Abdominal aortic aneurysms (AAAs) are the enlargement of main arteries within the abdominal region, and are predominantly found in males aged over 65. Recognised causes of this condition include high blood pressure and smoking. Traditionally, AAAs have been repaired using the Open Surgical Repair (OSR) technique which requires opening the patient's abdomen (a laparotomy) and hand-sewing a synthetic graft to replace the abnormal dilated blood vessel. This is typically undertaken as a preventative measure to prevent the risk of rupture which is fatal in 80% of cases. It is a robust but highly invasive technique. Recent advances in vascular surgery have resulted in the development of less invasive techniques, such as Endovascular Aneurysm Repair (EVAR). This involves the delivery of stent-grafts (crimped synthetic grafts, known as endoprostheses, attached to a metal scaffold, as visible on the x-ray) to the site of the aneurysm to reline the artery and protect the weakened blood vessel from the buffeting effects of the pulse. EndoAnchors are used to effectively stitch the endoprosthesis to the aorta from within the blood vessels itself. This can be done as a 'pinhole' procedure via the groin arteries without necessitating a laparotomy. This procedure has high success rates, less physical stress, early discharge and low mortality (less than 2%), with the advantage that surgery can be conducted whilst the patient is awake. Patients can be conveniently followed up with x-rays and scans which provide interesting images such as the one represented here.

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