Endovascular Abdominal Aortic Aneurysm Repair (EVAR)

Since it was first described in 1986, endovascular aneurysm repair (EVAR) has become the preferred treatment option for many patients with abdominal aortic aneurysms. EVAR requires extensive preoperative planning including appropriate patient selection, detailed imaging, measurements, and graft selection. There are various intraoperative pitfalls, such as vascular access and endoleaks, which the surgeon must be able to identify and troubleshoot. This chapter provides an overview of the steps of the procedure as well as management of potential issues that may arise. One advantage of EVAR over open repair is that it may be performed under anesthesia suited to the patient's needs. All patients undergoing EVAR will require preoperative imaging. Computed tomography arteriography with three-dimensional reconstructions is the most common and the most useful for planning. Once the surgeon has decided EVAR is a suitable option for an individual patient, the next crucial step is selection of the stent-graft itself.