Endovascular aneurysm repair (EVAR) is a type of minimally-invasive endovascular surgery used to treat pathology of the aorta, most commonly an abdominal aortic aneurysm (AAA). When used to treat thoracic aortic disease, the procedure is then specifically termed TEVAR for "thoracic endovascular aortic/aneurysm repair." EVAR involves the placement of an expandable stent graft within the aorta to treat aortic disease without operating directly on the aorta. In 2003, EVAR surpassed open aortic surgery as the most common technique for repair of AAA, and in 2010, EVAR accounted for 78% of all intact AAA repair in the United States.
Standard EVAR is appropriate for aneurysms that begin below the renal arteries, where there exists an adequate length of normal aorta (the "proximal aortic neck") for reliable attachment of the endograft without leakage of blood around the device ("endoleak"). If the proximal aortic neck is also involved with the aneurysm, the patient may be a candidate for complex visceral EVAR with a fenestrated or branched EVAR.
Patients with aneurysms require elective repair of their aneurysm when it reaches a diameter large enough (typically greater than 5.5 cm) such that the risk of rupture is greater than the risk of surgery. Repair is also warranted for aneurysms that rapidly enlarge or those that have been the source of emboli (debris from the aneurysm that dislodges and travel into other arteries). Lastly, the repair is also indicated for aneurysms that are the source of pain and tenderness, which may indicate impending rupture. The options for repair include traditional open aortic surgery or endovascular repair.
Endovascular procedures aim to reduce the morbidity and mortality of treating arterial disease in a patient population that is increasingly older and less fit than when major open repairs were developed and popularized. Even in the early days, significant risks were accepted in the understanding that the large open operation was the only option. That is not the case in most patients today.
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Ce cours est une préparation intensive à l'examen d'entrée en 3ème année de Médecine. Les matières enseignées sont la morphologie macroscopique (anatomie) , microscopique (histologie) de la tête, du c
L' consiste en une dilatation localisée avec perte du parallélisme des parois de l'aorte dans sa portion abdominale. La localisation la plus fréquente se situe en dessous des artères rénales, c'est-à-dire dans la dernière portion de l'aorte. On parle d'anévrisme lorsque le diamètre transversal maximal du vaisseau est supérieur à 1,5 fois la normale ; en deçà, on parle d'ectasie. Son diamètre peut parfois atteindre , la normale étant de à après 65 ans, variable en fonction du sexe et de la morphologie de la personne.
Minimally invasive procedures (also known as minimally invasive surgeries) encompass surgical techniques that limit the size of incisions needed, thereby reducing wound healing time, associated pain, and risk of infection. Surgery by definition is invasive and many operations requiring incisions of some size are referred to as open surgery. Incisions made during open surgery can sometimes leave large wounds that may be painful and take a long time to heal.
vignette|upright=0.6|Exemple de chirurgie vasculaire: retrait d'une plaque d'athérome dans la carotide. La chirurgie vasculaire est la chirurgie des vaisseaux, artères et veines, à l'exclusion des vaisseaux intracrâniens et coronaires. Chirurgie artérielle Traite non seulement les occlusions artérielles aiguës (ischémie aigüe de membre) et chroniques (artériopathie oblitérante), les anévrismes artériels, les dissections artérielles (dissection aortique de type B) mais aussi les traumatismes artériels (plaies graves chez les polytraumatisés), les malformations arterio-veineuses, créé des fistules arterio-veineuses (accès pour hémodialyse), assiste sur les transplantations d’organes lors de gestes sur les vaisseaux compliqués.
Endovascular embolization techniques are showing an extraordinary potential to treat patients suffering from complex neurovascular malformations. The embolization with liquid embolic agents via Onyx is a prominent approach to treat arteriovenous malformati ...
Aortic diseases are characterized by dire prognosis and inadequate diagnosis, owing to their insidious yet lethal nature. Aortopathies, namely aortic aneurysms and dissections, along with certain congenital diseases, might necessitate surgical replacement ...
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Compliant vascular grafts for implantation in the vasculature are provided. The compliant vascular grafts are designed to expand longitudinally and radially within a blood vessel, such as an artery, and is expected to be particularly well suited for treati ...