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Abdominal Endovascular Aneurysm Repair (EVAR)

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Minimally Invasive Alternative For AAA Repair

Abdominal endovascular aneurysm repair (EVAR) is a minimally invasive alternative to major open surgery for the repair of abdominal aortic aneurysms (AAAs) that results in reduced recovery times and potentially improved survival rates.

Illustration showing inside the human body with an abdominal aortic aneurysm

Abdominal Aortic Aneurysm

An abdominal aortic aneurysm (AAA) is a localized bulging or abnormal enlargement of the abdominal aorta, most often the infrarenal and aorto-iliac arteries.

  • 2.4 million global AAA prevalence1
  • 308,000 patients with AAA that is treatable1
  • AAAs cause over 175,000 deaths globally, accounting for 1% of deaths in men over 65 years2,3
  • At least 65% of patients with a ruptured AAA die of sudden cardiovascular collapse before arriving at a hospital4
Graphic showing abdominal aortic aneurysm prevalence, treatable patients, deaths, and cardiovascular collapse numbers

Causes

  • Degeneration caused by atherosclerosis
  • Trauma
  • Cystic medial necrosis
  • Arteritis
  • Syphilis
  • Inherited connective tissue disorders

Risk Factors

  • Over 65 years old
  • Smoker (or former smoker)
  • Family history of AAA
  • High blood pressure
  • High cholesterol
  • Poor leg circulation or COPD
  • Had heart bypass surgery
  • Obesity

Detection Challenges

Detection can be difficult. Most AAAs are asymptomatic. Frequently, they are discovered on X-rays performed for other reasons.

The mortality rate is high2 due to rupture,3 making timely detection and repair critical.

Screening Recommendations

United States Preventative Services Task Force recommends:

One-time screening for men 65 or older, particularly if the patient is an ever-smoker or has a family history.

 

Patient Education Video

Use this 3-minute video to explain AAAs, risk factors, and treatment options.

AAA Repair Procedures

Two of the most common methods of repairing AAAs are traditional open surgery and endovascular aortic repair (EVAR). 

Open Surgery

In the surgical procedure, the walls of the aneurysm are replaced with a synthetic graft. 

Illustration showing a body during open surgery for abdominal aortic aneurysm

EVAR Procedure

In the EVAR procedure, a stent graft is inserted into the aneurysm through small incisions in the groin.

Minimally invasive endovascular aneurysm repair using the abdominal stent graft.

Illustration showing a body during endovascular aneurysm repair for abdominal aortic aneurysm

Endovascular Aortic Repair (EVAR) 

EVAR of the abdominal aorta is performed using an AAA stent graft. The AAA stent is placed within the aneurysm to provide a permanent, alternative conduit for blood flow within the patient’s vasculature, thereby excluding the aneurysmal sac from blood flow and pressure and preventing the walls of the aneurysm from rupturing.

The AAA stent graft is inserted into the aneurysm through small incisions in the groin and without surgically opening or removing part of the aorta, thereby offering an alternative treatment choice to open surgery.

The Endurant II/IIs System Family of Products

You can be confident in your outcomes.

Optimize outcomes for the broadest patient base with:

  • A design that addresses sac regression5,6
  • The solution for everyday or extraordinary challenges
  • A long legacy of clinical success7-9

Only the Endurant™ II/IIs stent graft system has the deep clinical experience and favorable clinical outcomes designed to treat both straightforward and challenging anatomy.

Endurant™ II/IIs AAA stent graft system on white background

Endurant™ II/IIs AAA stent graft system

Deployment
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Endurant IIs Stent Graft System

View an animation of an Endurant IIs stent graft system deployment.

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References

1

Patient Access Acceleration Report. Medtronic data on file, 2019.

2

Mortality Statistics Series. Office of National Statistics. 2013. Available at: www.statistics.gov.uk. Accessed August 4, 2014.

3

Institute for Health Metrics and Evaluation. Global burden of disease study. Available at: http://www.healthmetricsandevaluation.org/gbd/visualizations/gbd-cause-patterns. Accessed August 4, 2014.

4

Rahimi SA. Abdominal Aortic Aneurysm. MedScape. March 11, 2020. Available at: https://emedicine.medscape.com/article/1979501-overview#a1. Accessed May 8, 2020.

5

Arko FR, Jordan WD Jr, Robaina S, et al. Interdisciplinary and Translational Innovation: The Endurant Stent Graft…from Bedside to Benchtop and Back to Bedside. J Endovasc Ther. December 2011;18(6):779-785.

6

Wakefield TW, Shulkin BL, Fellows EP, Petry NA, Spaulding SA, Stanley JC. Platelet Reactivity in Human Aortic Grafts: A Prospective, Randomized Midterm Study of Platelet Adherence and Release Products in Dacron and Polytetrafluoroethylene Conduits. J Vasc Surg. February 1989;9(2):234-243.

7

Teijink JAW, Power AH, Böckler D, et al. Editor’s Choice — Five Year Outcomes of the Endurant Stent Graft for Endovascular Abdominal Aortic Aneurysm Repair in the ENGAGE Registry. Eur J Vasc Endovasc Surg. August 2019;58(2):175-181.

8

Bisdas T, Weiss K, Eisenack M, et al. Durability of the Endurant stent graft in patients undergoing endovascular abdominal aortic aneurysm repair. J Vasc Surg. November 2014;60(5):1125-1131.

9

Singh MJ, Fairman R, Anain P, et al. Final Results of the Endurant Stent Graft System in the United States Regulatory Trial. J Vasc Surg. July 2016;64(1):55-62.