Chapter 73 - EVAR techniques

Question 1

Examples of positive fixations of endografts

Answer 1

1) hooks 2) anchors 3) barbs 4) staples

Question 2

Column support of endograft

Answer 2

Straddle Aortic bifurcation

Question 3

Friction fixation

Answer 3

outward radial force

Question 4

Risk factors for limb thrombosis post EVAR

Answer 4

1) iliac injury 2) calcification 3) tortuosity 4) excessive oversizing

Question 5

Aorto-uni-iliac grafts currently available

Answer 5

1) ReNu 2) Endurant

Question 6

Relative indication for aorto-uni-iliac graft

Answer 6

1) small < 15 mm distal aorta 2) severe unilateral iliac occlusive disease 3) secondary treatment of migration of short body graft

Question 7

Slice diameter on CTA cutoff for planning regular and fen grafts

Answer 7

Regular < 2.5 mm Fen < 1 mm

Question 8

Non-contrast CT for EVAR planning can miss these things

Answer 8

1) laminated thrombus at neck 2) patency of side branches 3) occlusive iliac disease

Question 9

Alternative to CTA in renal failure patients

Answer 9

1) IVUS 2) CO2

Question 10

Sizing measurement technique

Answer 10

Adventitia to adventitia except for Gore (intima to intima based on their trial)

Question 11

Oversizing amount

Answer 11

10-20% proximal neck (3-4 mm larger)

Question 12

EVAR size range currently can accommodate this range of aortic necks

Answer 12

18-36 mm graft for 16-32 necks

Question 13

Risks of oversizing and general cutoff

Answer 13

20% risk of pleating

Question 14

Conical sizing how to do

Answer 14

Split the difference Cannot use endo if > 4 mm change in a 15 mm neck

Question 15

Shortest main body graft and its lengths

Answer 15

Endurant II Ipsi 103 mm Contra 80 mm

Question 16

Iliac diameter oversizing amount

Answer 16

10-20%; usually 1-3 mm larger

Question 17

Landing in EIA specific consideration

Answer 17

land > 15 mm away from major angulation

Question 18

CIA seal length

Answer 18

2-3 cm

Question 19

Generic EVAR limits

Answer 19

1) neck 10-15 mm 2) angle 45-60 degrees (Aorfix 90 degrees) 3) Neck < 32 mm

Question 20

Percutaneous access benefit and con

Answer 20

1) less groin infection 2) less lymphocele 3) reduce procedure time 4) shorter LOS Con 5) increase cost 6) difficult to convert

Question 21

Percutaneous access limit in EVAR in terms of size of sheaths

Answer 21

< 24F

Question 22

Success rate of proglide

Answer 22

18-20F 78-95% 12-16F 95-99%

Question 23

Relative contraindication to percutaneous access

Answer 23

1) severe groin scarring 2) high femoral bifurcation 3) need multiple introducer changes 4) proximal iliac occlusive disease 5) small iliofemoral artery 6) anterior calcified femorals

Question 24

Balloon expandable sheaths

Answer 24

SoloPath Onset Medical Groups 11.5-15Fr dilates to 17-24Fr

Question 25

Iliac conduit steps

Answer 25

1) flank incision retroperitoneal 2) end-to-end on distal CIA 3) tunnel into groin incision 4) end-to-side on CFA or ligate stump at the end

Question 26

Typical neck angle for EVAR

Answer 26

Cranial 5-15 LAO 10-20

Question 27

Typical renal orientation

Answer 27

Right anterior Left posterior

Question 28

Settings for initial aortogram

Answer 28

20 ml/s for 7-15 ml

Question 29

Failure to cannulate gate strategies

Answer 29

1) arm access 2) up and over 3) AUI FFBY

Question 30

Minimal iliac landing

Answer 30

2 cm more if larger aneurysmal sac

Question 31

Completion run setting on injector

Answer 31

15 ml/s for 30 ml keep running for 5s post iliac contrast washout for type 2

Question 32

Palmaz loading principle

Answer 32

allow proximal balloon inflation first

Question 33

Treatment for Type 1A endoleak

Answer 33

1) balloon again 2) cuff 3) palmaz 4) endoanchors

Question 34

Endoanchor principle: neck size and numbers needed

Answer 34

<29 mm needs 4 anchors > 29 mm needs 6 anchors

Question 35

Endoanchor size and dimention

Answer 35

4.5 mm long 3 mm diameter wires are 0.5 mm diameter

Question 36

Indication to treat Type II endoleak

Answer 36

Sac growth > 5 mm

Question 37

IMA embolization prior to EVAR evidence

Answer 37

weak

Question 38

% of type 2 that were actually occult type 1 or 3

Answer 38

20%

Question 39

Treatment of Type 2 endoleak

Answer 39

1) embolize via transarterial, translumbar, transcaval 2) laparoscopic IMA clip 3) open ligate of lumbar/IMA 4) conversion to open graft sew

Question 40

Rate of Failure to treat type 2

Answer 40

20%

Question 41

Current EVAR stent grafts and their FDA approval time

Answer 41

Question 42

Current EVAR grafts and their specific sizes and features

Answer 42