ENDOVASCULAR REPAIR OF ABDOMINAL AORTIC ANEURYSMS 

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

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

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.