Maham Rahimi, MD, PhD, M. Mujeeb Zubair, MD, and Luis Gomez, MD demonstrate endovascular repair (EVAR) of abdominal aortic aneurysm.
This video demonstrates endovascular aneurysm repair, often abdominal aortic aneurysm in a 74 year old gentleman who presented with a 5.7 centimeter infra renal abdominal aortic aneurysm, then at me off. This aneurysm made it feasible to perform an endovascular repair. Bilateral common family arterial excesses obtained using a mini stick needle under ultrasound guidance. This is followed by introduction off a micro puncture wire, followed by the micro punctures sheet. Pence and wires are then introduced, followed by introduction off six French sheets pilot ready to dilate the common criminal Artery access site and to allow for passage off the park. Close Proglide Closure defense. The Proglide devices are then advance in bilateral goings and deployed in two in 10 o'clock configuration. Once the proglide, our pre deployed, the wires are introduced back, followed by in production off a nine French sheet. This is followed by introduction off a burnt catheter into the descending thoracic iota over a soft in a glide wire. This is done to introduce super stiff Amplats while into the descending thoracic iota. Once the super stiff Amplats wire introduced big sheets depending upon the size of the devices to be used are introduced in bilateral cohen. These sheets are advance and the philosophy. A pigtail catheter is then introduced in an abdominal aorta. Graham, that run office performed better dealing yet and at me and for sizing purposes, the main body off the end. A graft is then introduced from the right growing excess site and just placed in for originally to be deployed. The fiduciary markers shown on the screen are obtained by fusing the fluoroscope. Pick images with preoperative CT angiogram using bony landmarks as reference. The red marker on the screen. Done. It's the right renal, largely the smaller left marker towards the top end of the screen units. The left renal artery and the larger green marker, along with purple marker, demonstrates or indicates the Iot technique. The sheet is then gently pulled back in the main body off the end. A graft is then subsequently deployed was the main body off the end. A graft is deployed, the contra lateral sheet is withdrawn and a burn catheter is then introduced through this sheet, using a combination off the burn catheter in soft angle glide wire. The contra lateral gate is then calculated to ensure that the gate is calculated. A pigtail catheter is introduced through this lame and rotated 1 80 degrees. An angiogram is then performed to determine the origin off the hyper gastric artery before introducing our contra lateral limb. The length off the contra lateral limb to be used is determined by the markers on the pigtail catheter. Next, a stiff wire is then introduced through this pigtail catheter before introduction off the contra lateral name. Once this while is introduced, a contra lateral limb is then advance to the contra lateral gate. This is followed by subsequent deployment off this contra lateral limb, and Elliott claim extension is then brought in place and deployed with the distant lending zone in the left common iliac artery just above the hyper gastric artery. The collateral limits, then deployed in an angiogram, is then performed to determine the origin off the right hyper gastric artery. Once this is determined, an FC lateral limb extension is then brought in place, and this is then subsequently deployed with the distant lending zone just above the right hip of gastric artery in the right common iliac artery, proximal and distal sons off biotics. 10 graphs are then balloon angioplasty aid along with the area's off overlap. This is done for adequate sealing off the end. A graph to die. Ah, tick wall to the aortic wall in the common iliac arteries. Once this ballooning is completed, a completion angiogram is then performed to determine adequate opposition off biotics. 10 graph to die. Ah, tick in common iliac artery walls, presence off taipan type two or type three under leagues are also determined during the completion. India Graham Once a completion angiogram is performed, the wire and sheets are removed from the goings and the Proglide suitors are then cinched down and tightened. This is done for bilateral access sites. Caramel Cornick. It is then passed around these futures to make sure adequate he most cases has been achieved. This concludes our video on endovascular aneurysm repair off abdominal aortic aneurysm