Use of endoluminal aortic stent-grafts for the repair of abdominal aortic aneurysms

Abdominal aortic aneurysms affect approximately 1.5% of the United States population. Randomized trials recommend repair when the maximal aneurysm diameter is 5.5 cm or greater. Since the first report of this technique in 1991, endovascular repair has become the preferred method for elective therapy of AAA disease. This has been a direct result of reported decreased hospital length of stay, reduced patient recovery time and improved survival. The application of endovascular aneurysm repair (EVAR) requires a thorough understanding of aneurysm anatomy, which is critical for appropriate patient selection. In particular the surgeon must be familiar with device-related criteria for proximal fixation and distal fixation as well as access vessels size, tortuosity, and calcification which can often be the limiting factor in the application of EVAR. Although the reported results of EVAR indicate significant advantages when compared with conventional open repair, it is critical to have an understanding of the particular complications associated with EVAR. The development of endoleaks, reports of stent migration and stent fracture as well as the development of limb stenosis and/or occlusion have been reported in up to 20% of patients treated with EVAR and thus necessitate appropriate long-term surveillance protocols.