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Endovascular repair of abdominal aortic aneurysm

Rabih A Chaer, MD
Section Editors
Joseph L Mills, Sr, MD
John F Eidt, MD
Emile R Mohler III, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS


Endovascular aneurysm repair (EVAR) is an important advance in the treatment of abdominal aortic aneurysm (AAA). EVAR is performed by inserting graft components folded and compressed within a delivery sheath through the lumen of an access vessel, usually the common femoral artery. Upon deployment, the endograft expands, contacting the aortic wall proximally and iliac vessels distally to exclude the aortic aneurysm sac from aortic blood flow and pressure (figure 1).

Compared with open AAA repair, EVAR is associated with a significant reduction in perioperative mortality, primarily because EVAR does not require operative exposure of the aorta or aortic clamping. Since the approval of endograft devices for use in the United States, there has been a 600 percent increase in the annual number of EVAR procedures performed, with EVAR accounting for nearly half of AAA repairs. Concurrent with the increased use of EVAR, a decrease in the incidence of ruptured AAA and associated morbidity and mortality has been reported in the United States, likely due to the ability to offer EVAR to patients who would not otherwise be candidates for open surgical repair [1,2].

Endovascular repair of abdominal aortic aneurysm is reviewed here. General issues regarding the management of abdominal aortic aneurysm, and the clinical features and diagnosis of this condition, are presented separately. (See "Management of asymptomatic abdominal aortic aneurysm".)


The abdominal aorta is the most common site of arterial aneurysm. The abdominal aorta is defined as aneurysmal when a localized dilation is identified, and the diameter of the dilated region is increased more than 50 percent relative to normal aortic diameter [3]. The normal diameter of the aorta at the level of the renal arteries is approximately 2.0 cm (range 1.4 to 3.0 cm). An aortic diameter greater than 3.0 cm is considered aneurysmal for most individuals.

Aortoiliac anatomy — The abdominal aorta is a retroperitoneal structure that begins at the hiatus of the diaphragm and extends to its bifurcation into the common iliac arteries at the level of the fourth lumbar vertebra (figure 2). It lies slightly left of the midline to accommodate the inferior vena cava which is in close apposition. The branches of the aorta (superior to inferior) include the left and right inferior phrenic arteries, left and right middle suprarenal arteries, the celiac axis, superior mesenteric artery, left and right renal arteries, possible accessory renal arteries, left and right gonadal arteries, inferior mesenteric artery, left and right common iliac artery, middle sacral artery and the paired lumbar arteries (L1-L4).


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Literature review current through: Sep 2016. | This topic last updated: Nov 4, 2015.
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