Endovascular Aneurysm Repair with the Brazilian Technique

Overview of EVAR

The American College of Radiology recommends EVAR as a minimally invasive procedure for treating abdominal aortic aneurysms, which involves placing a stent graft within the aneurysm to exclude it from circulation, preventing rupture 1
EVAR has demonstrated significantly decreased perioperative morbidity, mortality, and hospital stay compared to open repair, with a strength of evidence supported by the American College of Radiology 1, 2

More than 50% of patients have aneurysm morphology unsuitable for conventional EVAR, often due to unfavorable neck anatomy, according to the American College of Radiology 2
Conventional EVAR requires a neck size >10-15mm in length and <30mm in diameter for adequate proximal graft seal, as specified by the American College of Radiology 2

The American College of Radiology states that EVAR requires lifelong imaging surveillance due to higher rates of complications requiring reintervention compared to open repair 1
Follow-up imaging should allow measurement of aortic aneurysm diameter, detection and classification of endoleaks, and detection of morphologic details of the stent grafts, as recommended by the American College of Radiology 1
The American College of Cardiology recommends CT angiography at 1 month, 6 months, and then yearly to confirm proper graft position and absence of endoleaks 3

The European Heart Journal describes five types of endoleaks, with types I and III most commonly leading to rupture, and recommends correction with a new endovascular procedure 4
Type II endoleaks occur in about 25% of patients but may seal spontaneously in approximately 50% of cases, according to the European Heart Journal 4