Abstract
Despite improvements in diagnostic and therapeutic methods and an increased awareness of their clinical significance, abdominal aortic aneurysms (AAAs) continue to be a major source of morbidity and mortality. Endovascular repair of AAAs, initially described in 1990, offers a less-invasive alternative to conventional open repair. The technology and devices used for endovascular repair of AAAs have progressed rapidly and the approach has proven to be safe and effective in short to midterm investigations. Furthermore, several large trials have demonstrated that elective endovascular repair is associated with lower perioperative morbidity and mortality than open repair. The long-term benefits of endovascular repair relative to open repair, however, continue to be studied. In addition to elective repair, the use of endovascular repair for ruptured AAAs has been increasing, and has been shown to be associated with reduced perioperative morbidity and mortality. Advances in endovascular repair of AAAs, including the development of branched and fenestrated grafts and the use of implantable devices to measure aneurysm-sac pressures following stent-graft deployment, have further broadened the application of the technique and have enhanced postoperative monitoring. Despite these advances, endovascular repair of AAAs remains a relatively novel technique, and further long-term data need to be collected.
Key Points
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Endovascular stent graft repair is a less-invasive technique than open surgery for the treatment of abdominal aortic aneurysms, involving relining of the diseased aorta instead of replacement, circumventing the need for major abdominal surgery and associated morbidity and mortality
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Endovascular stent grafts have developed rapidly to include a variety of different devices and adjunctive technologies, which have broadened the spectrum of patients who are candidates for endovascular repair
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The early results of the DREAM and EVAR 1 trials confirmed the benefits of endovascular repair compared with open repair; however, longer-term data are required as the durability of endovascular repair is a concern
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Studies have shown that there is a correlation between lower sac pressures in patients with complete aneurysm exclusion and sac shrinkage over time, however, it is unclear whether measuring sac pressures will have a role in postoperative surveillance for patients who undergo endovascular aortic repair
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The use of branched and fenestrated endovascular stent grafts might allow more patients to undergo endovascular repair; however, there are complications specific to the use of these devices
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ML Marin is a scientific advisory board member for Remon Medical. The other authors declared they have no competing interests.
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Baril, D., Jacobs, T. & Marin, M. Surgery Insight: advances in endovascular repair of abdominal aortic aneurysms. Nat Rev Cardiol 4, 206–213 (2007). https://doi.org/10.1038/ncpcardio0849
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DOI: https://doi.org/10.1038/ncpcardio0849