Bifurcated devices in the treatment of abdominal aortic aneurysms: limitations and advantages of a single-component bifurcated prosthesis.
Currently, prostheses for endovascular repair of abdominal aortic aneurysms are divided into 2 device categories. Endoprostheses based on the first approach arise from the concept that endovascular grafting should ideally mimic standard surgical repair of abdominal aortic aneurysms. The second category of devices developed from a design strategy that was a conceptual outgrowth of transcathete-based techniques in which an endovascular graft is constructed de novo within the abdominal aorta from modular components. Both grafts are dependent on the successful exclusion of blood flow from the aneurysm sac. Ongoing clinical trials of these 2 categories of devices have yet to be completed with long-term data, but it is apparent even at this early stage that there exist both advantages and limitations to each system. In this review, these issues are discussed for single-component bifurcated endografts within the context of our 5-year experience gained through the use of a bifurcated device produced by Endovascular Technologies, Inc (EVT). Overall, present limitations of the single-component bifurcated prosthesis are related to graft size and the somewhat cumbersome maneuvers required for implantation. Nonetheless, the inherent advantages of these prostheses, including their durability and capacity to respond to aneurysm remodeling without late device failure, may ultimately provide the patient with a prosthesis with superior long-term clinical performance characteristics.
Edwards
W H
WH
Saint Thomas Hospital, Department of Surgery, Vanderbilt University School of Medicine, Nashville, TN, USA.
Naslund
T C
TC
D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D011474:Prosthesis Design; D015607:Stents