Endovascular repair EVAR-aortic aneurysms

(Circ 2015;131:1291; NEJM 2019;380:2126)

• Requires favorable aortic anatomy
• TEVAR (thoracic EVAR) for descending TAA ≥5.5 cm may ↓ periop morbidity and possibly mortality (Circ 2010;121:2780; JACC 2010;55:986; J Thorac CV Surg 2010;140:1001 & 2012;144:604)
• AAA: guidelines support open repair or EVAR for infrarenal AAA in good surg candidates ↓ short-term mort., bleeding, LOS; but long-term graft complic. (3–4%/y; endoleak, need for reintervention, rupture) necessitate periodic surveillance, with no difference in mortality long term, except ? in those <70 y (Lancet 2016;388:2366; NEJM 2019;380:2126) In Pts unfit for surgery or high periop risks: ↓ aneurysm-related mortality but no ∆ in overall mortality over med Rx (NEJM 2010;362:1872). EVAR noninferior (? superior) to open repair in ruptured AAA w/ favorable anatomy (Ann Surg 2009;250:818).