الفهرس 
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Abstract
The aorta is the largest artery in the body. The aorta begins at the top of the left ventricle. The abdominal aorta begins at the aortic hiatus of the diaphragm, in front of the lower border of the body of the last thoracic vertebra, and ends on the body of the fourth lumbar vertebra, by dividing into the two common iliac arteries. An aneurysm is an abnormal dilatation in the wall of an artery. Normally, the walls of arteries are thick and muscular, allowing them to withstand a large amount of pressure. Occasionally, however, a weak area develops in the wall of an artery. This allows the pressure within the artery to push outwards, creating a bulge or ballooned area called an ”aneurysm”.
Aneurysms can form in any blood vessel, but they occur most commonly in the aorta , And Abdominal aortic aneurysms occur in the part of the aorta that passes through the middle to lower abdomen.
Aortic aneurysms are classified by shape, location along the aorta, and how they are formed. And In 1986, Crawford described the first TAAA classification scheme based on the anatomic extent of the aneurysm.
Aortic aneurysms are most often caused by damage to the artery’s wall due to atherosclerosis, Other causes of aortic aneurysms may include: Some Congenital disorders.
Most aortic aneurysms have no symptoms. In fact, most are diagnosed on a chest X-ray or computerized tomography (CT) scan performed for evaluation of another condition,. Symptoms may occur, however, due to the aneurysm pressing on nearby organs or tissue, or if the aneurysm leads to dissection.
Abdominal aortic aneurysm is a common vascular disease that affects elderly population, and it is a common cause of death worldwide, with increasing incidence and prevalence.
Open surgical repair is regarded as the gold standard technique for treatment of abdominal aortic aneurysm, however, endovascular aneurysm repair has rapidly expanded since its first introduction in 1990s. As a less invasive technique, endovascular aneurysm repair has been confirmed to be an effective alternative to open surgical repair, especially in patients with co-morbid conditions.
Computed tomography (CT) angiography is currently the preferred imaging modality for both preoperative planning and post-operative follow-up.
The aim of anesthesia is to have a hemodynamically stable, n ormothermic, pain free patient on completion of surgery. The majority of UK vascular anesthetists use a balanced general anesthetic technique (high dose opioid, oxygen, air, low dose volatile agent) with a thoracic epidural. Thoracic epidurals ameliorate the stress response to surgery, reducing cardiovascular demands. Epidurals provide high quality postoperative analgesia.
Traditionally, EVAR is performed under regional or general anesthesia. Preferred to be in a hybrid room. It needs good preoperative, intraoperative, postoperative management and good patient preparation.
There are some complications with EVAR , the most common of them are endoleaks. and organs ischemia and their incidence can be decreased by taking some precautions.