Limitations of current EVAR endografts and potential solutions for their deficiencies.
All current endovascular aneurysm repair (EVAR) devices have defined limitations that prevent the endovascular therapist from using them to treat all forms of aortoiliac aneurysm disease. Short, angulated infrarenal aortic neck pathology, occlusive disease in iliac access arteries, need for preservation of important branch vessel arterial flow, endograft migration, and endoleak all represent major impediments for successful EVAR. Need for secondary intervention after EVAR in a significant number of patients has detracted from universal acceptance for this therapy. New devices in manufacturers' pipelines may provide solutions for many of the current EVAR device deficiencies. As these new devices become more complex, meticulous patient follow-up to verify anticipated outcomes and new training paradigms for the future endovascular therapist will be required.
Texas A&M University Health Science Center, College of Medicine and Division of Vascular Surgery, Scott & White Healthcare, Temple, TX 76508, USA. cbuckley@swmail.sw.org
Clifford J
CJ
Buckley
Shirley D
SD
Buckley
D001014:Aortic Aneurysm / Q000175:diagnosis / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000193:education / Q000295:instrumentation*; D002983:Clinical Competence; D004503:Education, Medical, Graduate; D057510:Endovascular Procedures / Q000009:adverse effects / Q000193:education / Q000295:instrumentation*; D006801:Humans; D017543:Iliac Aneurysm / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D015607:Stents; D017211:Treatment Failure