![]() ![]() The implications of an inefficient planning can be seen immediately-or after the procedure-by endoleaks’ formation or late aneurysm sac growth. Adequate planning is an essential and indispensable step for technical success, in order to promote appropriate adjustment of the graft to the vessel wall and consequently aneurysm sac exclusion with blood flow reorientation. ![]() Different from OSR, EVAR relies on knowing the patient’s anatomy well enough to choose the appropriate device preoperatively. The development of new modern devices (with features that can adapt to different morphologic presentations of this aortic disease, which in the past were considered as not eligible for EVAR), like low-profile delivery systems, comformability and flexibility, has required some new aptitudes beyond endovascular skills for this type of repair, directly related to specific technical knowledge of each brand’s endograft and their usage facing each patient’s anatomy.Ĭonsequently, the image study in the pre-operatory time took the uttermost importance in order to ensure the adequate selection of patient candidates for EVAR, the decision to endograft type and size, and additional details for postoperatory follow-up. EVAR has progressively replaced open surgical repair (OSR), especially in the infrarenal territory, representing currently over half of the surgeries for abdominal aneurysms. Over the last decades, since the first published results by Juan Parodi in 1991, endovascular aneurysm repair (EVAR) became the vascular surgeon’s most preferential technique to treat aortic aneurysms due to its benefit of early clinical and surgical outcomes with good long-term durability. As an alternative, a simpler technique through image manipulation on the software OsiriX/Horos, aiming to reduce both exposures, is presented. Although some studies propose effective strategies to optimize the procedure, they rely on the use of additional specific and advanced equipment, available only in major centers. Thus, a meticulous study of the angio-CT during EVAR preparation allows the reduction of unnecessary radiation exposure, as it also reduces consecutive image acquisition and contrast use (that may be related to renal overload in susceptible patients). The increase of endovascular surgeons’ interest on tomography image edition through software is marked specially when the increasing frequency of these procedures and its complexity have impelled surgeons to face additional and successive risk to occupational radiation exposure. It is known that endovascular aneurysm repair (EVAR) requires a precise deployment of the graft and so the anatomical and morphological characteristic study of the aorta and its branches is mandatory.
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