OR / Prep · Vascular Surgery · percutaneous
You’re scrubbing into
EVAR (endovascular aneurysm repair)
Why are we operating?
Relining an abdominal aortic aneurysm from inside: a fabric-covered stent graft delivered up the femoral arteries and deployed across the sac, excluding it from pressure without opening the abdomen.
Indication: Infrarenal AAA at threshold (about 5.5 cm, or rapid growth), with anatomy that offers a sealing zone below the renal arteries and iliac access that admits the device.
The operation in 4 steps
01Planning on the CT
02Femoral access
03Deployment
04Completion and surveillance
Danger zones
Femoral artery
Every access, every anastomosis, every groin stab wound: this is the vessel in question.
Femoral vein
Immediately medial to the artery, the structure a misplaced arterial puncture finds, and the wall of the femoral canal.
Femoral nerve
Lateral and OUTSIDE the femoral sheath; retractor injury costs knee extension.
Watch it done
NEJM procedure: deployment of an endovascular graft in an abdominal aortic aneurysm
The journal's procedure video: access, the main body, the contralateral limb and the completion angiogram.
Source: NEJM Group · Watch on YouTubeEndovascular aneurysm repair (EVAR)
The plain-language overview of the stent graft and life after it.
Source: University Hospitals · Watch on YouTube
Conceptual teaching for learners preparing to observe and assist under supervision, not operative instructions. Five minutes from now you should know why this operation exists, what its shape is, and which structures it is designed not to injure.