Endoluminal repair of infrarenal abdominal aortic aneurysms

Abstract

Endoluminal repair of abdominal aortic aneurysms (AAA) offers an attractive alternative to open surgical repair. Early experience has shown that endoluminal repair can be performed safely, with low morbidity and mortality rates. Data from non-randomised studies have demonstrated that the endoluminal technique has certain advantages when compared with open repair in carefully selected patients. These include shorter hospital stay, decreased use of intensive-care beds and lower blood loss. The major drawback to endoluminal repair is the durability of the stent grafts. Registers of endoluminal devices have shown that, even after successful repair, new endoleaks may occur after apparently successful deployment and the transverse diameter of the aneurysm may continue to expand, even in the absence of an endoleak. Some of the devices have developed problems with the integrity of either the stent or its graft covering, which could result in aneurysm rupture. Manufacturers have recently been criticised for not releasing data on adverse events. No randomised trials comparing endoluminal with open repair of infrarenal AAA have yet been performed, however, financial support has recently been granted for a multicentre UK study (endovascular aneurysm repair — EVAR). This trial will randomise patients who are deemed fit for operation to either open repair or endovascular repair (EVAR 1) and patients regarded as unfit to best medical treatment, or best medical treatment with endovascular repair (EVAR 2).

Key Words:

• Endoluminal repair
• abdominal aortic aneurysms
• stent graft
• endoleak