Endovascular stent graft repair of abdominal aortic aneurysms: Current status and future directions

Abstract

Endovascular stent graft repair of abdominal aortic aneurysm (AAA) has undergone rapid developments since it was introduced in the early 1990s. Two main types of aortic stent grafts have been developed and are currently being used in clinical practice to deal with patients with complicated or unsuitable aneurysm necks, namely, suprarenal and fenestrated stent grafts. Helical computed tomography angiography has been widely recognized as the method of choice for both pre-operative planning and post-operative followup of endovascular repair (EVAR). In addition to 2D axial images, a number of 2D and 3D reconstructions are generated to provide additional information about imaging of the stent grafts in relation to the aortic aneurysm diameter and extent, encroachment of stent wires to the renal artery ostium and position of the fenestrated vessel stents. The purpose of this article is to provide an overview of applications of EVAR of AAA and diagnostic applications of 2D and 3D image visualizations in the assessment of treatment outcomes of EVAR. Interference of stent wires with renal blood flow from the hemodynamic point of view will also be discussed, and future directions explored.

One-year multicenter results of 100 abdominal aortic aneurysm patients treated with the Endurant stent graft

“…2,5 One should be aware that these patients are often also considered as challenging patients in open surgery. 3 These patients might, therefore, actually benefit most from EVAR. The introduction of newer stent grafts with wider inclusion criteria, therefore, could be a step forward in treating these patients with AAAs.…”

Outcomes of Elective Endovascular Aneurysmal Repair for Abdominal Aortic Aneurysms in Jordan

“…Since Parodi et al [4] published the first case, EVAR has been considered a revolutionary development in vascular surgery [10]. The techniques of EVAR and the inventory of new devices have progressed rapidly to overcome the early device failure [12,13].…”

“…As recommended, unfavorable necks including short neck length, severe proximal or distal angulations, severe calcifications, or the presence of thrombus in the neck were frequently excluded [4,11,14]. Furthermore, there is a learning curve in acquiring the skills necessary to adopt new endovascular technologies, and skilled experience will result in superior outcomes [12,15]. In our series, the operating time, amount of contrast, and blood products used improved remarkably over time.…”

“…However, because of concerns of repeated exposure to radiation and nephrotoxic contrast, we started to include DUS surveillance during long-term follow-up. Some studies have reported that DUS showed similar detection of endoleaks as CT as well as a lower cost and avoidance of the ionizing radiation and contrast [10,12,30].…”

A tissue‐engineered aneurysm model for evaluation of endovascular devices

“…Devices are undergoing development that consist of various characteristics such as bifurcated geometries, specialized suprarenal components, and fenestrations to accommodate specific regions of the aorta and unique patient anatomies. 9 Investigation of different endovascular device materials can lead to improved mechanical attributes including tensile strength, burst strength, and flexibility. An additional area of stent graft research and development has involved the use of surface modifications aimed at modifying and enhancing vascular healing following device implantation.…”