Endovascular aortic aneurysm repair

In 1991, Parodi’s utilization of a balloon-expandable stent graft delivered endovascularly under fluoroscopy to treat abdominal aortic aneurysm (AAA) ushered in a new era in vascular surgery. AAAs are typically the result of chronic loss of vascular structural proteins and subsequent decrease in aortic wall strength. Abdominal B-mode ultrasound is the most frequently used screening modality to look for AAA. EVAR is increasingly being used to treat ruptured AAA. Computed tomographic angiography (CTA) requires exposure to radiation as well as intravenous contrast material. Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) both offer radiation-free alternatives to CT and conventional angiography for AAA imaging. Blood flow in the aneurysm sac after stent graft deployment is known as an endoleak. EVAR has been validated as an effective treatment for abdominal aortic aneurysms in a number of randomized controlled trials, including the DREAM, the OVER, and EVAR 1 trials.