Endovascular Treatment of Abdominal Aortic Aneurysms

Abdominal aortic aneurysms (AAA) may now be treated by endovascular placement of an arterial graft. These grafts are inserted through the femoral artery and then secured to the aorta above and below the aneurysm. The procedure reduces the risk of many perioperative complications and reduces hospital costs and length of stay. Several FDA-approved clinical trials are currently in progress with a variety of different devices. None is available for general use at this time. Overall, more than 800 grafts have now been placed, with a primary success rate of greater than 80%. Several complications have been reported, but the incidence of complications has generally decreased as proficiency has improved. The most troublesome problem has been leak of blood around the graft with continued risk of aneurysm rupture; therefore, follow-up CT scans and clinical examinations are mandatory to allow for appropriate treatment. Future modifications of current devices and techniques for delivery can be expected to reduce the incidence of currently identified problems. Endovascular grafting for AAA offers important potential advantages over conventional repair and may become increasingly important in the management of patients who have an abdominal aortic aneurysm.