In this procedural case review, vascular surgeon Dr. Samuel Steerman demonstrates endovascular aneurysm repair (EVAR) for a patient in their 70s with an abdominal aortic aneurysm. The video highlights key aspects of stent-graft placement, patient selection considerations, and the role of EVAR in reducing the risk of aneurysm rupture while offering a minimally invasive treatment approach.
Hi, I'm Samuel Steerman, a surgeon with Centerovascular Specialists, and today we're taking care of a patient in their 70s who's developed an abdominal aortic aneurysm. This is the model of the aneurysm. You can see it's a focal outpouching of the aorta, and this is rather lifelike, with a normal blood vessel above and below. And in those situations, the patient is a good candidate for a stent graft repair or an endovascular aortic aneurysm. These are the blood vessels to the kidneys. And this model shows our plan for today on how to manage this. While this stent is lifelike and life size, it will be crimped down very tight as it goes inside the femoral. Arteries and then gets deployed in this area. You can see that there's a connection point right here. As we deploy one side, we'll then bring a stent up from the other side, from the left side, connect the, the stents together, and then deploy to the other side. Now the purpose of this is not to remove the aneurysm, but to shunt the blood flow down to the legs without having the blood flow go into the aneurysm, therefore reducing the chance that the patient is going to suffer a ruptured aneurysm and die. This depends upon the seal zones here, here, here, and of course here. We'll move now to the operating room. Here's the CAT scan for our patient, which clearly shows a normal blood vessel at the top and the bottom of the screen, and then the aneurysm in the mid portion. And as we cycle through a combination of axial, sagittal, and coronals, you can see that there is a focal aneurysm within the infrarenal abdominal aorta, and this is the typical aneurysm we see walking down the street, very focal, somewhat large to the point that it needs repair, but the blood vessels above and below are fairly normal, and that makes the patient a good candidate for an endovascular repair, or also known as a stent graft repair. Here we are at Virginia Beach General Hospital in operating room 4, and the patient's under only moderate sedation for this procedure. I've gained access to the femoral artery with an IV and placed one on either side. You can see we're placing numbing medication, lidocaine, right here to help with the local anesthesia with the moderate sedation. Now we've introduced our devices into the patient's body. This is the device that holds the stent graft, and you can see one of our catheters, a flexible plastic tube coming from the patient's left. The device is now coming up from the right with the nose cone heading towards the top. This is our angiogram to take pictures of the blood vessel. You can see the sweeping renal arteries at the top third of your screen. Below that, the normal aorta, and then below that, while poorly visualized here, is the aneurysm. Now we will begin with our stent graft repair or endovascular aortic aneurysm repair. As the stent is unsheathed, you can see it deploy again at the top third of the screen. Because we need to build this from both sides, this is an additional stent going in on the patient's left at the tip towards the nose cone is the device, and the rest of it is the delivery system. This gets inserted through the left femoral artery, and you can see that ring-like device that's about at the middle of the screen coming down. That is unsheathing our stent in place right within the aorta into the iliac artery as we continue to deploy there. Now we have balloons which are provided at seal zones and overlap segments, and our completion angiogram shows the stent is right where it needs to be. There's good flow to the kidneys, good flow to the legs, and we've excluded the aneurysm successfully. The patient spends one night in the hospital and would be discharged the following day.
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