Endovascular aneurysm repair

From Ganfyd

Jump to: navigation, search

EVAR. A method of repairing eg abdominal aortic aneurysms, first described in 1991.[1] Also the name given to two trials involving this technology.

A graft is threaded from distal access under radiological guidance through the aneurysm sac and secured to the arterial wall above and below with an ingenious device. The sac is left and clots up.

Evidence

  • EVAR1[2]
    • Showed that 30 day mortality was better with EVAR compared to open repair.short
  • EVAR2
  • DREAM[3][4]

Long-term follow-up (15 years) has now shown that the survival benefit is lost after 6 to 8 years with 1 extra death per 100 person years related to aneurysm after 8 years compared to open surgery. However the all cause mortality survival curves only diverge after 11 years. There is a higher rate of death from secondary sac rupture and cancer[5].

References