EVAR reintervention management strategies in contemporary practice

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Medical Device Technology

Background:

• Endovascular aneurysm repair (EVAR) is a common procedure for treating abdominal aortic aneurysms.
• Complications such as endoleaks, device migration, and graft issues can necessitate reintervention after EVAR.
• Contemporary management strategies for these complications are crucial for long-term patient outcomes.

Purpose of the Study:

• To review and discuss current management strategies for reinterventions following endovascular aneurysm repair (EVAR).
• To outline endovascular treatment options for various post-EVAR complications.
• To highlight the shift towards catheter-based interventions in managing EVAR failures.

Main Methods:

• Review of contemporary literature and practice guidelines for EVAR reinterventions.
• Categorization of reintervention strategies based on specific EVAR complications (e.g., endoleaks, migration, endotension).
• Discussion of various endovascular techniques, including angioplasty, stent-graft placement, embolization, and novel device applications.

Main Results:

• Type I endoleaks are managed with balloon angioplasty, stent-graft extensions, or proximal stent placement.
• Type II endoleaks may be treated conservatively or with embolization techniques if symptomatic.
• Type III endoleaks typically require additional stent graft components; endotension is managed with endovascular conversion or sac content removal; migration is addressed with large stents or securing devices.

Conclusions:

• Catheter-based interventions are the primary treatment modality for reinterventions after EVAR in current practice.
• A range of endovascular techniques are available to manage diverse post-EVAR complications.
• The evolution of endovascular technology continues to refine reintervention strategies, emphasizing minimally invasive approaches.