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TEVAR EVAR

Introduction

Abdominal Aortic Aneurysm

In this disease, the abdominal aorta is enlarged to 1.5 times of the normal diameter. It is the most common arterial dilatation disease. It can be life-threatening once it’s ruptured and bleeding. Abdominal aortic aneurysm cannot heal itself if left untreated. Once ruptured, its mortality rate is as high as 70% to 90%. But its mortality rate after elective surgery can be dropped to less than 5%. Therefore, early diagnosis and early treatment should be performed.

Symptoms

(1) Pulsatile mass: It can be found by physical examination at the umbilicus or upper left of the umbilicus, and it has a roundish shape. Its pulse is consistent with the heartbeat;
(2) Pain: Mainly in the abdomen and lower back. The huge aneurysm can compress and erode the vertebral body, causing radicular pain. Sudden acute abdominal pain is often a sign of rapid expansion or even rupture of the aneurysm;
(3) Compression: Manifested as compression of surrounding organs, and associated symptoms, such as epigastric fullness, and urinary tract obstruction;
(4) Embolism: Mainly because the thrombus in the aneurysm cavity falls off and is rushed by the blood flow to the distal portion, causing arterial embolism in the lower limbs, and ischemic necrosis of the limbs;
(5) Rupture: Rupture is the most severe clinical problem of this disease, and it is manifested as sudden severe abdominal pain, hemorrhagic shock, and presence of the pulsatile mass in the abdomen.

Diagnosis

Ultrasound Doppler

Computer Tomography

MRA

Magnetic resonance angiography

DSA

Digital Subtraction Angioplasty

Abdominal aortic aneurysm above 3 cm in diameter can be detected, and the aneurysm size, presence of plaque and thrombus can be identified.

Plain scan and enhanced scan can accurately reveal the shape of the aneurysm and its adjacent relationship with the surrounding organs, so doctors can determine whether there is an anatomical abnormality, and find out whether there are other concomitant intra-abdominal diseases. Three-dimensional computed tomographic angiography (3DCTA) can demonstrate the three-dimensional morphological characteristics and size of the aneurysm, as well as the affected abdominal aorta branches more accurately. It can also accurately measure the parameters of each part of the aneurysm.

MRA can show the location, size, and shape of the lesion clearly without any contrast agent, and provide a vivid image. It has high diagnostic value for the subacute or chronic hematoma caused by aneurysm rupture.

It is of great value for the diagnosis of thoracoabdominal aortic aneurysm, multiple aneurysms and aortic dissection. It cannot provide the real image of the aneurysm cavity, when there is a large amount of mural thrombus in the aneurysm cavity.

Treatment

Abdominal Endovascular Aneurysm Repair (EVAR)

Introduction to Surgery

Under the DSA, the stent graft was delivered into the abdominal aorta through the bilateral common femoral artery, using a special delivery system. It is placed into the aneurysm cavity according to the precise positioning set before surgery. Making use of the self-expanding nature of the metal stent and the barb of the bare stent, the stent is fixed to the arterial wall at the proximal and distal ends of the aneurysm, so as to completely cut off the impact of high-pressure blood flow from the abdominal aorta on the aneurysm wall. Meanwhile, secondary thrombus and organization will occur to blood on the aneurysm wall and stent graft, so as to isolate the lesion and treat the disease.