ENDOVASCULAR REPAIR OF ABDOMINAL AORTIC ANEURYSMS 

The Journal of Cardiovascular Surgery 2003 August;44(4):519-25

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

The choice of stent-graft for endovascular repair of abdominal aortic aneurysm

Chuter T. A. M.

Department of Surgery, University of California San Francisco, CA, USA

The aim of this study was to ­explain vari­a­tions in the ­results of endo­vas­cular aneu­rysm ­repair as a con­se­quences of ­device ­design. Low pro­file, track­able ­systems, ­such as ­Zenith and ­Excluder, ­rarely ­fail to tra­verse the ­iliac ­arteries, ­even in the pres­ence of ­iliac tor­tu­osity or sten­osis. In ­most ­patients, ­optimal ­sizing is ­only pos­sible ­with ­systems, ­such as ­Zenith, ­Talent, and ­Quantum lp, ­that ­have a ­wide ­range of diam­e­ters. ­Short, angu­lated ­necks ­call for a ­high ­degree of flex­ibility and ­secure, ­barb-­enhanced prox­imal fix­a­tion, ­which are fea­tures of ­Excluder, ­Zenith and ­Ancure. The ­main ­risk fac­tors for rup­ture are migra­tion, ­type III endo­leak, and aneu­rysm dil­a­ta­tion. Migra­tion ­rates are ­high for ­devices, ­such as ­AneuRx, ­that ­have nei­ther ­barbs nor suprar­enal ­stents. Aneu­rysm ­shrinkage ­occurs at ­high ­rates ­with non-­porous ­stent-­grafts, ­such as ­Zenith, ­Talent, and ­Ancure, but at far ­lower ­rates ­with ­porous ­stent-­grafts, ­such as ­Excluder and ­AneuRx. ­Type III endo­leak, due to ­fabric ­failure or com­po­nent sep­ar­a­tion, was a ­common ­failure ­mode for the Van­guard ­device, but is ­rare ­with ­newer ­devices. ­Suture ­breakage, ­barb sep­ar­a­tion and ­stent ­breakage ­occur fre­quently, yet clin­ical con­se­quences, ­such as endo­leak or rup­ture, are ­rare. ­Graft throm­bosis is ­also ­unusual ­when the pros­theses is ­fully-­stented. In con­clu­sion, modern ­devices are ­more ver­sa­tile, ­more effec­tive, and ­more dur­able ­than ­their ­first gen­er­a­tion coun­ter­parts.