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Endovascular Stent Graft for Aortic Diseases

China

The first 20% of the full text of this article appears below.

Endovascular aortic stent grafting remained one of the most significant developments in vascular surgery in the last decade since its first introduction in 1991. Today at least a dozen commercial devices are available for treating a wide spectrum of diseases in the thoracic and abdominal aorta. The minimally invasive concept of transfemoral introduction of a self-expanding stent graft system using a small groin incision, or even percutaneously, often under local or minimal anaesthesia, is appealing to surgeons and patients alike. Considerable experience has been gained from endovascular repair of abdominal aortic aneurysms, and we are seeing an increase in the usage of this technology to treat more complex abdominal and thoracic diseases.

ENDOVASCULAR REPAIR FOR ABDOMINAL AORTIC ANEURYSM (AAA)

Compared to the gold standard of open aneurysm repair, endovascular repair for AAA (EVAR) has the advantage of avoiding laparotomy, aortic clamping, and minimizing blood loss, resulting in shorter intensive care and hospital stays. Large prospective randomized studies such as the UK EVAR-1¹ and DREAM² trials have confirmed that EVAR has a significantly lower hospital mortality (1.7 vs 4.7%) and reduced morbidity compared to traditional open repair. The price is a higher incidence of access related injuries, and a need for continuous surveillance with a possibility of secondary interventions and rupture.

The Achilles heel of EVAR is its durability. Critiques state that the hospital stay and quality of life advantages will disappear with the tedious follow up protocol. The procedure is more expensive, and the results are poorer in larger aneurysms with complex anatomy. Indeed earlier registries such as the EUROSTAR reported re-intervention and rupture rates . . . [Full Text of this Article]