Endovascular repair of abdominal aortic aneurysms: the Cleveland Clinic experience with five different devices

Abstract

The endovascular repair of abdominal aortic aneurysms is associated with long-term durability that is inferior to that of traditional open surgical repair. Device migration, endoleak, and limb thrombosis continue to plague currently available devices, culminating in an unacceptably high rate of secondary procedures and, in rare cases, failure to protect the patient from rupture. A review of the available literature yields a few caveats: certain correlations that exist between device design features and the risk of graft-related complications during and after implantation. Noteworthy in this regard are associations between bulky deployment systems and iliofemoral arterial injury, unsupported (nonstented) graft limbs and thrombotic occlusion, fabric/stent motion and fabric degeneration, rigid endoskeletons and limb disunion, as well as passive proximal attachment and device migration. Whereas the last decade has witnessed improvement in endograft device design, endovascular aneurysm repair still must be considered a technology in evolution. Early benefit of reduced periprocedural morbidity is negatively affected by inferior long-term durability of current technology. Nevertheless, many patients, particularly those who are elderly or infirm, may choose to accept the limitations of current endovascular technology to avoid the increased morbidity of traditional open surgical aneurysm repair.