EVAR (2023 – CME)- online course

Description

Authors: T. Rand and R. Uberoi

Reviewers: T. Kratimenos, J. Nadjiri, C. Nice, B. Peynircioglu and T. Pfammatter

This course corresponds to chapter 2.2.1.1.3 Acute aortic syndromes and aneurysmal disease in the European Curriculum and Syllabus for IR.

Abstract

Minimal invasive vascular repair of abdominal aortic aneurysm was first reported in 1986. In the early 1990s endovascular aneurysm repair (EVAR) was developed for the treatment of patients unfit to undergo open surgical repair, but the procedure has since evolved into the primary method of treatment.

Stent graft devices have been designed for both abdominal and thoracic aneurysms (TEVAR) and have shown the early benefit of significantly reducing morbidity and mortality. However, in the longer term, there is loss of the early survival benefit with a cross-over at 4 years.

Anatomical features that may make standard EVAR difficult or impossible are poor quality necks including features such as inadequate neck diameter and length, or angulation shape and thrombus.

To overcome these morphological limitations of stent grafts, huge technical advancements have been made in terms of design, such as the introduction of fenestrated and branched devices. However, these special devices can take time to manufacture, which has prompted the development of innovations such as parallel-type grafts called chimneys and snorkels.

High-quality cross-sectional imaging, predominantly CT, is required for case planning to ensure the selection of the optimal device for patients.

Endoleaks are the most frequent complication of EVAR and the detection and characterisation of these endoleaks are vital in decision-making for further treatment.

EVAR and TEVAR have now replaced many of the open surgical repair programmes in the majority of hospitals with interventional and diagnostic radiology playing a major role in this vascular service.

Learning objectives

• To learn about pre-procedural imaging work-up for the treatment of aortic aneurysms
• To provide knowledge about the full range of endovascular treatment options for aortic aneurysms
• To classify thoracic and abdominal aortic aneurysms with respect to suitability for EVAR and define the required anatomical information for adequate case selection and planning
• To learn about the limitations of EVAR
• To learn about advanced and complex techniques
• To learn about specific issues, such as the sealing zone and how to overcome anatomical limitations
• To learn about the common complications of EVAR including “endoleaks”, their imaging characteristics and the indications for re-interventions
• To learn about the common complications and their treatment options
• To learn about the techniques of EVAR, use of current stent graft devices and post-procedural follow-up.

Further information

This course covers a basic level of IR knowledge and is designed for trainees, students or young consultants aiming to acquire essential knowledge or prepare for the EBIR exam. Thereby, it is tailored to the European Curriculum and Syllabus for IR and corresponds to chapter 2.2.1.1.3 Acute aortic syndromes and aneurysmal disease.

The format of the course is interactive and easy to use, including texts, graphics, videos and a quiz to support your learning. The course duration is around one hour and is accredited by the European Accreditation Council for Continuing Medical Education (EACCME) to award 1 European CME credit (ECMEC). The CME accreditation for this course will expire on January 2, 2025. A non-CME accredited version of the course will remain available for two more years.

The acquired CME Certificate will be available in the myCIRSE area under CIRSE Academy.

The enrolment period of this course is linked to the validity of the All-Access Pass.

Release date: January 2023