Results of clinical research to improve EVAR

Abstract

An aneurysm is a permanent localized (i.e., focal) dilation of an artery that has at least a 50% increase in diameter compared with the expected normal diameter of the artery in question. For practical reasons, however, most reports document an aneurysm of the infrarenal aorta when diameter reaches 3 cm or more. The risk of an aneurysm is rupture, and therefore the treatment goal is to treat the aneurysm long before it has been ruptured. It was not until 1991 that an aneurysm was treated by means of an open repair. The advances notwithstanding, open aneurysm repair continues to cause substantial morbidity and requires a prolonged hospital admission and intensive care stay as well as a long recovery period. In addition, a significant number of patients are deemed high-risk candidates for open repair because of significant comorbidities. All of these issues provided a major incentive for the development of less invasive procedures. In 1991, Parodi et al. in Argentina and Volodos et al. in the Ukraine both reported a technique for endovascular aneurysm repair. Since then, treatment of aneurysms of the abdominal aorta shifted from open repair to the less invasive endovascular repair. In this thesis, the long-term outcome of this treatment modality is described alongside the possible complications. Also, we mentioned many anatomical aneurysm and stent-graft fixation risk factors which influence outcome after endovascular aneurysm repair. And finally we describe the use of endovascular stent-grafts to treat other arterial pathology: the para-anastomotic aneurysm after previous open repair. The long-term results were good. Most complication could be resolved by means of a second endovascular procedure. We identified many risk factors which influence the durability of this procedure. When treating patients by means of this procedure, the risk factors have to be taken into account. The treatment of paraanastomotic aneurysms was promising and should replace the open repair to treat these kind of late complications after previous open repair. Overall, the endovascular treatment of patients with an aneurysm of the abdominal aorta will increase and eventually all patients will be treated by means of an endovascular technique.