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n CME : Your SA Journal of CPD - Aortic stentgrafts and endovascular abdominal aortic aneurysm repair : main article

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Abstract

  1. Aortic stentgrafts have expanded the treatment options for repair of abdominal aortic aneurysms.
  2. Surgery and EVAR are complementary, not competitive, treatment strategies.
  3. Current stentgraft configuration for EVAR involves a modular, bifurcated, design. Thoracic stentgrafts employ a tube configuration, with current limitations involving obtaining an adequate seal in the aortic arch and bulky, rigid, delivery devices.
  4. Current limitations to EVAR include hostile proximal aortic neck anatomy, difficult iliac access, and small calibre vessels in females.
  5. EVAR in appropriate patients has excellent early and improving intermediate results. In experienced hands it is safe and effective.
  6. The magnitude of surgery may be reduced by the adjunctive use of aortic stentgrafts ('hybrid' procedures for complex aortic aneurysm repairs).
  7. EVAR, despite being minimally invasive, is not a lesser procedure. The magnitude of procedure-related complications rivals that associated with open surgery.
  8. In the long term, EVAR is more expensive than surgery.
  9. The long-term durability of aortic stentgrafts has yet to be defined.
  10. EVAR is less invasive, but patients require serial long-term follow-up and imaging surveillance, with increased probability of secondary reinterventions (approximately 40% are free of reinterventions at 5 years). This needs to be discussed with patients.

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/content/m_cme/25/7/EJC63349
2007-07-01
2016-12-08
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