Endograft Repair of Abdominal Aortic Aneurysm: The Premise, The Promise, The Data
The successful endovascular treatment of abdominal aortic aneurysm has long been a goal of interventionalists. Parodi's placement of a custom-made tube endograft in a patient in 1991 initiated a period of intense activity, innovation, and progress. In slightly under two decades the treatment of AAA has been transformed from an exclusively open surgical procedure to an often endovascular, and sometimes percutaneous intervention. New devices and approaches to endovascular repair continue to appear, and the shift away from open surgery for even complex cases continues.
The premise of endovascular repair is that isolation of the abnormal walls of the aorta from direct exposure to arterial flow by the endograft is protective against aortic rupture. The protection could be conferred by several mechanisms either alone or in combination, such as depressurization, alteration in flow dynamics, or change in the wall itself. The promise is an effective treatment that has low morbidity and cost compared to conventional surgery. As the data from randomized prospective trials, large case controlled studies, and large registries emerge, the results have fallen somewhat short of expectations. The realities of treating a poorly understood disease with an evolving technology have resulted in the creation of new conditions (such as “endoleak” and device migration), new procedures to treat the new conditions, and new requirements for follow-up.
There is little doubt that the endovascular approach to aortic aneurysm repair will continue to grow in importance and application. Whether placement of an endograft alone will ever be sufficient to achieve the desired protection from aneurysm rupture in a low cost, low maintenance manner remains to be determined.
- © 2010 by American Heart Association, Inc.