The Current Status of AAA Stent Grafting

ABSTRACT

It is now 16 years since the endovascular treatment of abdominal aortic aneurysm (AAA) was first described. It is probably true to say that, with current device technology, > 50% of all patients with an infrarenal aneurysm can be treated with an endograft. Endografting has become an important tool in the treatment of AAA. There are many reasons for this success. Rapid technical development followed the initial “homemade” devices, allowing easy accurate insertion. In early cohort series it was always the case that the operative mortality of endografting in AAA was lower than surgical treatment. In addition, postoperative management was easier and hospital stay was shorter after an endograft. No evidence indicated that quality of life improved after the perioperative period, however, and it was unclear whether the reduction in intensive hospital care requirement justified the considerable extra costs for an endovascular device. Despite these shortcomings, early widespread public awareness pushed endograft treatment forward. Patients started to ask for this new treatment option. But long-term outcome data then, and to some extent today, are still lacking.

EVAR 1 and 2 Trials - DREAM Trial - Eurostar Registry - eEVAR

REFERENCES

• 1 The UK Small Aneurysm Trial Participants . Mortality results for randomised controlled trial of early elective surgery or ultrasonographic surveillance for small abdominal aortic aneurysms.  Lancet. 1998;  352 1649-1655
• 2 Lederle F A, Wilson S E, Johnson G R et al.. Immediate repair compared with surveillance of small abdominal aortic aneurysms.  N Engl J Med. 2002;  346 1437-1444
• 3 The UK Small Aneurysm Trial Participants . Long-term outcomes of immediate repair compared with surveillance of small abdominal aortic aneurysms.  N Engl J Med. 2002;  346 1445-1452
• 4 Legemate D A, Bossuyt P M. From innumeracy to insight: the uncertainty of help versus harm in treatment of asymptomatic aortic aneurysms.  Eur J Vasc Endovasc Surg. 2006;  32 620-623
• 5 Parodi J C, Palmaz J C, Barone H D. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms.  Ann Vasc Surg. 1991;  5 491-499
• 6 Blankensteijn J D, de Jong S E, Prinsen M et al.. Two-year outcomes after conventional or endovascular repair of abdominal aortic aneurysms. Dutch Randomized Endovascular Aneurysm Management (DREAM) Trial Group.  N Engl J Med. 2005;  352 2398-2405
• 7 Prinssen M, Verhoeven E L, Buth J et al.. A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms.  N Engl J Med. 2004;  351 1607-1618
• 8 Greenhalgh R M, Brown L C, Kwong G P et al.. Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR-1), 30-day operative mortality results: randomised controlled trial.  Lancet. 2004;  364 843-848
• 9 EVAR Trial Participants . Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): randomised controlled trial.  Lancet. 2005;  365 2179-2186
• 10 EVAR Trial Participants . Endovascular aneurysm repair and outcome in patients unfit for open repair of abdominal aortic aneurysm (EVAR trial 2): randomised controlled trial.  Lancet. 2005;  365 2187-2192
• 11 Prinssen M, Buskens E, Blankensteijn J D. Quality of life after endovascular and open AAA repair: results of a randomised trial.  Eur J Vasc Endovasc Surg. 2004;  27 121-127
• 12 Laheij R J, Buth J, Harris P L et al.. Need for secondary interventions after endovascular repair of abdominal aortic aneurysms: intermediate-term follow-up results of a European collaborative registry (EUROSTAR).  Br J Surg. 2000;  87 1666-1673
• 13 Fransen G A, Vallabhaneni Sr S R, van Marrewijk G J et al.. Rupture of infra-renal aortic aneurysm after endovascular repair: a series from EUROSTAR registry.  Eur J Vasc Endovasc Surg. 2003;  26 487-493
• 14 Drury D, Michaels J A, Jones L, Ayiku L. Systemic review of recent evidence for safety and efficacy of elective endovascular repair in the management of infrarenal abdominal aortic aneurysm.  Br J Surg. 2005;  92 937-946
• 15 Coppi G, Sillingardi R, Gennai S, Saitta G, Ciardullo A V. A single-center experience in open and endovascular treatment of hemodynamically unstable and stable patients with ruptured abdominal aortic aneurysms.  J Vasc Surg. 2006;  44 1140-1147
• 16 Visser J J, Bosch J L, Hunink M G et al.. Endovascular repair versus open surgery in patients with ruptured abdominal aortic aneurysms: clinical outcomes with 1-year follow-up.  J Vasc Surg. 2006;  44 1148-1155
• 17 Hoornweg L L, Wisselink W, Vahl A et al.. The Amsterdam Acute Aneurysm Trial: suitability and application rate for endovascular repair of ruptured abdominal aortic aneurysms.  Eur J Vasc Endovasc Surg. 2007; February 1 ;  , (Epub ahead of print)
• 18 Yilmaz L P, Abraham C Z, Reilly L M et al.. Is cross-femoral bypass grafting a disadvantage of aortomonoiliac endovascular aortic aneurysm repair?.  J Vasc Surg. 2003;  38 753-757
• 19 Hinchliffe R J, Alric P, Wenham P W et al.. Durability of femorofemoral bypass grafting after aortouniiliac endovascular aneurysm repair.  J Vasc Surg. 2003;  38 498-503
• 20 Amsterdam Acute Aneurysm Trial Collaborators . Amsterdam Acute Aneurysm Trial: background, design and methods.  Vascular. 2006;  14 1-6
• 21 Muhs B E, Verhoeven E L, Clark J et al.. Mid-term results of endovascular aneurysm repair with branched and fenestrated endografts.  J Vasc Surg. 2006;  44 9-15
• 22 Ohki T, Ouriel K, Silveira P G, Katzen B, White R. Initial results of wireless pressure sensing for endovascular aneurysm repair: the APEX Trial-Acute Pressure Measurement to confirm Aneurysm Sac Exlusion.  J Vasc Surg. 2007;  45 236-242