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ULTIMO FASCICOLOTHE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica

Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,632

Periodicità: Bimestrale

ISSN 0021-9509

Online ISSN 1827-191X

 

The Journal of Cardiovascular Surgery 2003 Agosto;44(4):527-34

ENDOVASCULAR REPAIR OF ABDOMINAL AORTIC ANEURYSMS 

Endovascular management of abdominal aortic aneurysms

Bush R. L., Lin P. H., Lumsden A. B.

Divi­sion of Vas­cular Sur­gery and Endo­vas­cular ­Therapy, Michael E. ­DeBakey Depart­ment of Sur­gery, Baylor Col­lege of Med­i­cine, ­Houston, TX, USA, Meth­o­dist Hos­pital, ­Houston, TX, USA

An esti­mated 1.5 mil­lion ­people in the ­United ­States ­have abdom­inal ­aortic aneu­rysms (­AAAs) ­with ­more ­than 200000 Amer­ican diag­nosed ­each ­year. The nat­ural his­tory ­of AAAs is to expand and rup­ture, ­accounting for an esti­mated 15000 ­deaths per ­year. ­Thus, the ­major ­impetus for AAA ­repair is for pro­phy­laxis ­against aneu­rysm-­related ­death. The stan­dard ­open sur­gical ­repair ­of AAAs is a ­well-estab­lished and dur­able pro­ce­dure. How­ever, as ­with all ­other ­major abdom­inal sur­gical oper­a­tions, asso­ciated ­signifìcant mor­bidity and mor­tality ­exist, ­along ­with pro­longed ­recovery and var­ious ­late com­pli­ca­tions. Fur­ther­more, ­both mor­tality and mor­bidity ­increase sig­nif­i­cantly ­with ­advanced ­patient age and asso­ciated co-­morbid dis­ease ­states. Endo­vas­cular AAA ­repair ­using cov­ered ­stent-­grafts ­offers a sig­nif­i­cantly ­less inva­sive alter­na­tive to con­ven­tional ­open-sur­gical ­repair. A con­sid­er­able reduc­tion in hos­pital ­stay has ­been dem­on­strated, ­with ­early ­return to pre­op­er­a­tive ­levels of ­activity. ­Patients pre­vi­ously con­sid­ered unsuit­able for ­open ­repair can ­often ­receive treat­ment for aneu­rysms ­with endo­vas­cular tech­niques. Cur­rent esti­mates are ­that ­more ­than 1/2 all infra­renal ­AAAs ­will be ­repaired ­using endo­vas­cular ­approach in the ­future. ­Despite the min­i­mally-inva­sive­ness of ­this new treat­ment, ­there are unan­swered ques­tions as to the dur­ability and effi­cacy of ­devices, ­which ­results in con­cerns ­about ­their ­ability to suc­cess­fully pro­tect the ­patient ­from sub­se­quent rup­ture. ­Three ­devices are com­mer­cially avail­able and ­have ­been exten­sively ­used for implan­ta­tion in the ­United ­States ­with a ­4th ­device ­recently ­receiving ­approval ­from the ­Food and ­Drug Admin­is­tra­tion (FDA). In ­this ­review ­article, endo­vas­cular man­age­ment ­of AAAs ­with ­these ­devices is ­described, as are the ­design and deploy­ment tech­niques of the cur­rently avail­able endo­grafts.

lingua: Inglese


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