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      Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm: A Comprehensive Review

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          Abstract

          Abdominal aortic aneurysm (AAA) can be defined as an abnormal, progressive dilatation of the abdominal aorta, carrying a substantial risk for fatal aneurysmal rupture. Endovascular aneurysmal repair (EVAR) for AAA is a minimally invasive endovascular procedure that involves the placement of a bifurcated or tubular stent-graft over the AAA to exclude the aneurysm from arterial circulation. In contrast to open surgical repair, EVAR only requires a stab incision, shorter procedure time, and early recovery. Although EVAR seems to be an attractive solution with many advantages for AAA repair, there are detailed requirements and many important aspects should be understood before the procedure. In this comprehensive review, fundamental information regarding AAA and EVAR is presented.

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          Most cited references63

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          Management of abdominal aortic aneurysms clinical practice guidelines of the European society for vascular surgery.

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            The EFSUMB Guidelines and Recommendations on the Clinical Practice of Contrast Enhanced Ultrasound (CEUS): update 2011 on non-hepatic applications.

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              Transfemoral intraluminal graft implantation for abdominal aortic aneurysms.

              This study reports on animal experimentation and initial clinical trials exploring the feasibility of exclusion of an abdominal aortic aneurysm by placement of an intraluminal, stent-anchored, Dacron prosthetic graft using retrograde cannulation of the common femoral artery under local or regional anesthesia. Experiments showed that when a balloon-expandable stent was sutured to the partially overlapping ends of a tubular, knitted Dacron graft, friction seals were created which fixed the ends of the graft to the vessel wall. This excludes the aneurysm from circulation and allows normal flow through the graft lumen. Initial treatment in five patients with serious co-morbidities is described. Each patient had an individually tailored balloon diameter and diameter and length of their Dacron graft. Standard stents were used and the diameter of the stent-graft was determined by sonography, computed tomography, and arteriography. In three of them a cephalic stent was used without a distal stent. In two other patients both ends of the Dacron tubular stent were attached to stents using a one-third stent overlap. In these latter two, once the proximal neck of the aneurysm was reached, the sheath was withdrawn and the cephalic balloon inflated with a saline/contrast solution. The catheter was gently removed caudally towards the arterial entry site in the groin to keep tension on the graft, and the second balloon inflated so as to deploy the second stent. Four of the five patients had heparin reversal at the end of the procedure. We are encouraged by this early experience, but believe that further developments and more clinical trials are needed before this technique becomes widely used.
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                Author and article information

                Journal
                Korean J Radiol
                Korean J Radiol
                KJR
                Korean Journal of Radiology
                The Korean Society of Radiology
                1229-6929
                2005-8330
                August 2019
                18 July 2019
                : 20
                : 8
                : 1247-1265
                Affiliations
                [1 ]Department of Radiology, Chonnam National University Hospital, Gwangju, Korea.
                [2 ]Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun, Korea.
                Author notes
                Corresponding author: Nam Yeol Yim, MD, Department of Radiology, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju 61469, Korea. Tel: (8262) 220-5746, apleseed@ 123456chonnam.ac.kr
                Author information
                https://orcid.org/0000-0003-2124-6299
                https://orcid.org/0000-0002-0319-7705
                https://orcid.org/0000-0003-1835-9452
                https://orcid.org/0000-0002-7774-3684
                https://orcid.org/0000-0002-5940-9359
                Article
                10.3348/kjr.2018.0927
                6658877
                31339013
                9aa2b774-93ec-4c91-b037-0da05141a239
                Copyright © 2019 The Korean Society of Radiology

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 29 December 2018
                : 02 May 2019
                Categories
                Intervention
                Review Article

                Radiology & Imaging
                abdominal aortic aneurysm,endovascular aneurysmal repair,stent-graft
                Radiology & Imaging
                abdominal aortic aneurysm, endovascular aneurysmal repair, stent-graft

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