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n CME : Your SA Journal of CPD - Aortic stentgrafts and endovascular abdominal aortic aneurysm repair : main article
- Aortic stentgrafts have expanded the treatment options for repair of abdominal aortic aneurysms.
- Surgery and EVAR are complementary, not competitive, treatment strategies.
- 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.
- Current limitations to EVAR include hostile proximal aortic neck anatomy, difficult iliac access, and small calibre vessels in females.
- EVAR in appropriate patients has excellent early and improving intermediate results. In experienced hands it is safe and effective.
- The magnitude of surgery may be reduced by the adjunctive use of aortic stentgrafts ('hybrid' procedures for complex aortic aneurysm repairs).
- EVAR, despite being minimally invasive, is not a lesser procedure. The magnitude of procedure-related complications rivals that associated with open surgery.
- In the long term, EVAR is more expensive than surgery.
- The long-term durability of aortic stentgrafts has yet to be defined.
- 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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