REVIEW  OUTCOMES AND CHALLENGES IN MODERN AAA REPAIR 

The Journal of Cardiovascular Surgery 2018 April;59(2):180-9

DOI: 10.23736/S0021-9509.17.10332-0

Copyright © 2017 EDIZIONI MINERVA MEDICA

lingua: Inglese

Outcomes of endovascular aortic repair in the modern era

Jacob BUDTZ-LILLY ^{1, 2} ✉, Anders WANHAINEN ², Kevin MANI ²

¹ Department of Cardio-Thoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark; ² Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden

Monitoring outcomes following endovascular aortic repair (EVAR) is critical. Although evidence from randomized controlled trials has solidified the role of EVAR, the analysis of outcomes and “real-world” data has uncovered limitations, improved the selection of appropriate patients, and underscored the importance of instructions for use. Subsequent studies demonstrated the learning curve of EVAR and gradual improvement of outcomes over time. Outcomes analyses will continue to play an important role, particularly as technological growth of endovascular therapy has enabled treatment of more complex aneurysm pathologies and patients. The important analyses are herein reviewed, following the development of EVAR in the treatment of intact abdominal aortic aneurysms (AAA) to ruptured AAAs, and finally to complex aneurysms, including thoracoabdominal aortic aneurysms and mycotic aneurysms. This includes an overview of the more recent results from analyses of branched and fenestrated EVAR, as well as the use of chimney grafts. It is emphasized that the success of endovascular repair has paradoxically been hampered by its rapid growth and early achievements. Even the most advanced engineering developments cannot overcome the long-term effects of the progression of aortic disease. The long-term benefits thus require careful planning and considerations of the natural history of aneurysms and the life expectancy of the patient. Large and international data registry collaborations should continue to play a role in providing outcomes analyses to guide future improvements.

KEY WORDS: Abdominal aortic aneurysm - Outcomes - Ruptured aneurysm - Stents - Vascular grafting