Current status of endovascular aneurysm repair: 20 years of learning.
Parodi first introduced endovascular aneurysm repair (EVAR) in 1991 and since that time it has been shown to have a lower 30-day morbididty and mortality compared to open surgery. Anatomic constraints governed by the need for adequate access vessels, and sufficient proximal and distal landing zones, as well as the need for long-term surveillance, have been the main limitations of this technology. Anatomic factors were initially estimated to exclude 40% of patients with abdominal aortic aneurysm (AAA). The rapid extension of EVAR technology has been complimented by improved access to both high-quality imaging modalities and a variety of endografts. These developments have led EVAR to become a more practical alternative for patients with ruptured AAA. Early data in this setting is encouraging with even more profound reductions in morbidity and mortality than seen in the elective repair.
Division of Vascular and Endovascular Surgery, Sanger Heart and Vascular Institute, Carolinas Medical Center, 1001 Blythe Avenue, Suite 300, Charlotte, NC 28203, USA. farkomd@gmail.com
Frank R
FR
Arko
Erin H
EH
Murphy
Christopher
C
Boyes
Tzvi
T
Nussbaum
Stephen G
SG
Lalka
Jeremiah
J
Holleman
Timothy S
TS
Roush
D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000639:trends; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000193:education / Q000295:instrumentation / Q000401:mortality / Q000639:trends*; D002983:Clinical Competence; D004503:Education, Medical, Graduate / Q000639:trends*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000193:education / Q000295:instrumentation / Q000401:mortality / Q000639:trends*; D006801:Humans; D059032:Learning Curve; D011474:Prosthesis Design; D015607:Stents / Q000639:trends; D013812:Therapeutics