Computed tomography angiog- raphy (CTA) is the mainstay of evaluation, with the ability to measure aneurysm dimensions, the diameters and lengths of the abdominal and pelvic arteries, as well as identify extensive throm- bus or calcifications.
TEVAR procedure A hybrid OR, which is outfitted with a full complement of OR equipment plus state-of-the-art imaging technology, is used for the TEVAR procedure in order to provide high-definition radio- graphic imaging and a mobile table. The patient, placed under general anesthesia and controlled ventilation, is positioned with groins, abdomen, and chest exposed.16 A radial artery cath- eter is placed to monitor systemic BP. The femoral artery is then accessed with an angiographic sheath, and a rigid guidewire is advanced to the ascending aorta under fluoroscopy. If needed, an angled glide catheter can steer the guide wire into the ascending aorta. A pigtail catheter inserted via the femoral artery is used to perform an aortogram. After the aortogram, the proximal neck is evaluated. The length and diam- eter of the proximal and distal neck are measured using the preoperative CTA, an intravascular ultrasound, and the aorto- gram.17 The stent graft is chosen based on these measurements.