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In 1991, the first aortic aneurysm repair using an aortic stent graft (endograft)
was reported. With this technique, a fabric covered metallic stent is inserted into
an abdominal aortic aneurysm without making an incision on the abdomen. The endograft
is placed within the abdominal aortic aneurysm by making an incision in the femoral
artery at the level of the groin and passing the device into the aneurysm while
watching its progress through the arterial system on an x-ray monitor. When the
device is seated properly within the aortic aneurysm, the endograft is released
from the introducer device and stays within the aneurysm to protect it from rupture.
The interval between 1991 and 1999 was a time of testing and refining of the aortic
endografts. Several trials using various devices were undertaken by vascular specialists
throughout the world. In November of 1999, the Food and Drug Administration (FDA)
approved two endografts for human use in the United States. Several other companies
developed endografts for aneurysm repair in the ensuing years.
The obvious advantage of the aortic endograft is that no abdominal incision is required.
Recovery from the operation is considerably shorter than with traditional (open)
aortic aneurysm surgery.
Follow-up data after placement of the aortic endograft is currently in the range
of about ten years. The early results with regard to prevention of aneurysm rupture
are quite good. This length of follow-up is relatively short compared to what we
know about traditional (open) aneurysm repair, however. The endograft is fitted
inside the aneurysm rather than sewn to the aorta. If the shape, diameter or length
of the aorta changes over a period of years, the endograft inside the aneurysm has
the potential to move and “slip down”. In such an instance, the endograft may no
longer protect the aneurysm from rupture. For this reason, close follow-up of patients
who have undergone endograft aortic aneurysm repair is advised to ascertain that
these devices will remain effective in preventing aneurysm rupture many years after
implantation. Follow-up by the patient’s surgeon on a regular basis (at least once
or twice a year) and regular examination with an ultrasound and/or CT scan study
is recommended by most vascular surgeons.
It is important to emphasize that not everyone is a candidate for placement of the
endograft device. There are certain stringent anatomical criteria that must be met
to allow for successful deployment of this device. The size of the normal aorta
above the aneurysm and the size of the iliac and femoral arteries below the aneurysm
are crucial for successful placement of the device. If the arteries leading to the
legs (iliac arteries) are too small or too atherosclerotic, it is not possible to
pass the device up the leg artery and into the aneurysm. If the aorta above the
aneurysm is too large, the device will not stay in place and may move out of its
The advisability of using the endograft surgical repair or the traditional (open)
aortic aneurysm surgery can only be determined by the vascular surgeon after review
of the CT scans and all other diagnostic data. The patient should seek advice from
a certified vascular surgeon who is trained to perform both the open and the endograft
surgery so that the most balanced opinion can be obtained.
Fits almost any patient
Fits only if anatomy is "right"
Abdominal or flank incision
Incision in groin
Performed in Operating Room
Average six days in hospital
Average two days in hospital
"Full recovery"- 6 weeks
"Full recovery"- 2 weeks
Follow-up data beyond 40 years
Follow-up data ten years
Device costs about $300
Device costs about $12,000