[Reconstruction of the aortic bifurcation: endovascular aortic repair (EVAR) and alternatives]

[Aortic bifurcation reconstruction : Endovascular repair and alternatives]

CLINICAL ISSUE

Aortic bifurcation disease is a manifestation of arteriosclerosis in about 95% of cases. Stenotic disease of the aortic bifurcation is a special form of peripheral arterial occlusive disease (PAOD). Men older than 60 years are particularly affected.

STANDARD TREATMENT

The potential of endovascular therapy has continued to increase. Hereby, the increased availability of hybrid operating suites which allow for a combined use of endovascular techniques and open surgery plays an important role.

DIAGNOSTIC WORK-UP

For the decision on the type of therapy and the sizing of the prosthesis, thin-slice CT angiography (CTA) of the abdominal aorta and the iliac arteries including multiplanar reconstructions in the sagittal and coronal planes is sufficient. The inguinal arteries have to be included in the CTA volume.

PERFORMANCE

Compared to open surgery, endovascular therapy of aortic bifurcation disease has the advantage of reduced invasiveness.

ACHIEVEMENTS

Treatment of aortic bifurcation disease continues to change. In daily practice, the standard treatment of complex aortic bifurcation disease is still open surgery. However, an increasing number of studies indicate that endovascular therapy and open surgery should be considered equivalent, complementary methods.

PRACTICAL RECOMMENDATIONS

Good quality preinterventional CTA is important for intervention planning. If you want to offer endovascular therapy as a radiologist, knowledge of interventional skills and close cooperation with clinical colleagues, particularly the vascular surgeon, is mandatory.