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  • Review Article
  • Published:

Endovascular treatment of abdominal aortic aneurysms

Nature Reviews Cardiology volume 11, pages 112–123 (2014)Cite this article

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A Correction to this article was published on 04 March 2014

This article has been updated

Key Points

  • Endovascular aneurysm repair (EVAR), rather than open repair, is currently the treatment of choice for most patients with an anatomically suitable infrarenal abdominal aortic aneurysm (AAA)

  • Clinical evidence-based research shows a lower perioperative morbidity and mortality, and similar long-term survival, for EVAR compared with open repair of suitable infrarenal AAAs

  • The indications for endovascular management of AAA are expanding to include increasingly complex and anatomically challenging aneurysms

  • Challenging anatomy might require the use of fenestrated and branched stent grafts, chimney grafts, or the sandwich technique

  • Future directions for stent grafts include fenestrated and branched off-the-shelf stent grafts, multilayer stents, endoanchor systems, and sac-anchoring endoprostheses

  • Stent graft technology for infrarenal AAA continues to evolve, with profile downsizing, optimization of sealing and fixation, and the use of fabrics with reduced porosity

Abstract

Patients with abdominal aortic aneurysms (AAAs) are usually treated with endovascular aneurysm repair (EVAR), which has become the standard of care in many hospitals for patients with suitable anatomy. Clinical evidence indicates that EVAR is associated with superior perioperative outcomes and similar long-term survival compared with open repair. Since the randomized, controlled trials that provided this evidence were conducted, however, the stent graft technology for infrarenal AAA has been further developed. Improvements include profile downsizing, optimization of sealing and fixation, and the use of low porosity fabrics. In addition, imaging techniques have improved, enabling better preoperative planning, stent graft placement, and postoperative surveillance. Also in the past few years, fenestrated and branched stent grafts have increasingly been used to manage anatomically challenging aneurysms, and experiments with off-label use of stent grafts have been performed to treat patients deemed unfit or unsuitable for other treatment strategies. Overall, the indications for endovascular management of AAA are expanding to include increasingly complex and anatomically challenging aneurysms. Ongoing studies and optimization of imaging, in addition to technological refinement of stent grafts, will hopefully continue to broaden the utilization of EVAR.

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Figure 1: Imaging modalities used in the management of patients with AAA.
Figure 2
Figure 3: A fenestrated stent graft.
Figure 4: A chimney graft.
Figure 5: Endovascular aneurysm repair strategies that enable the revascularization of up to four aortic side branches.
Figure 6: An off-the-shelf branched stent graft.
Figure 7: The multilayer stent graft.
Figure 8: The sac-anchoring system, consisting of two femorally inserted stent grafts with polymer-filled endobags on the outside of the stent.

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Change history

  • 04 March 2014

    In the version of this article originally published, the following statement was missing from the acknowledgements: This work was supported by the NIH T32 Harvard-Longwood Research Training in Vascular Surgery grant HL007734. This error has been corrected in the HTML and PDF versions of the article.

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Acknowledgements

The authors thank Thomas Curran M.D., Beth Israel Deaconess Medical Centre, Boston, MA, USA for his valuable editorial review of this manuscript. This work was supported by the NIH T32 Harvard-Longwood Research Training in Vascular Surgery grant HL007734.

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Authors and Affiliations

  1. Department of Vascular Surgery, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands

    Dominique B. Buck, Joost A. van Herwaarden & Frans L. Moll

  2. Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Centre, Harvard Medical School, 110 Francis Street Suite B, Boston, 02215, MA, USA

    Dominique B. Buck & Marc L. Schermerhorn

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D. B. Buck researched data for the article. D. B. Buck and J. A. van Herwaarden wrote the manuscript. All authors substantially contributed to discussion of content and reviewed and edited the manuscript before submission.

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Correspondence to Frans L. Moll.

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J. A. van Herwaarden is a consultant for Medtronic and Philips. M. L. Schermerhorn is a consultant for Endologix and Medtronic. F. L. Moll is a consultant for Medtronic. D. B. Buck declares no competing interests.

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Buck, D., van Herwaarden, J., Schermerhorn, M. et al. Endovascular treatment of abdominal aortic aneurysms. Nat Rev Cardiol 11, 112–123 (2014). https://doi.org/10.1038/nrcardio.2013.196

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