Improvement of patient eligibility with the use of new generation endografts for the treatment of abdominal aortic aneurysms. A comparison study among currently used endografts and literature review

Abstract

Background: Newer generation devices have attempted to accommodate a wider range of aortoiliac anatomies offering endovascular aneurysm repair (EVAR) to more patients with abdominal aortic aneurysms (AAAs). We aim to examine the anatomic suitability for the ultra-low profile Ovation endograft in our AAA patients and to compare them with other contemporary devices.

Methods: 158 consecutive AAA patients treated with EVAR or open surgical repair (OSR) were tested for EVAR eligibility according to the most commonly used endografts' instructions for use.

Results: 106 patients underwent EVAR and 52 OSR. EVAR eligibility was higher for the Ovation system (72%) compared to the rest of the devices (Incraft: 63%, Nellix: 60%, Endurant-II: 59%, Excluder: 55%, Zenith-Flex: 36%, Aorfix: 35%, P-value<0.001). Non-suitable proximal neck anatomy followed by access vessel inadequacy were the primary reasons for ineligibility.

Conclusion: New generation aortic endografts with innovative proximal sealing mechanisms and ultra-low profile delivery systems are increasing patient eligibility for EVAR.

Keywords: Endovascular aneurysm repair; aortic neck angulation; endograft sizing; endoleak; seal zone.