[Transluminally placed endovascular graft indications: thoracic aortic aneurysm and abdominal aortic aneurysm]

In 1991, Parodi et al described the first clinical use of a new technique for abdominal aortic aneurysm (AAA) repair using transluminally placed endovascular grafts (TPEG). Subsequently, in 1994 Dake et al reported the use of this new technique for the treatment of patients with aneurysms of the descending thoracic aorta. Since then, TPEG for the treatment of aneurysms have been clinically investigated in a number of centers. Initially, TPEG appeared to be an attractive alternative to standard surgical open repair, since they are less invasive and thereby reduce the operative risk in high-risk patients. The effectiveness and safety of TPEG have been reported by many investigators, and indications for this technique are increasing. However, the placement of TPEG within the artery by insertion via a remote site and fixation by attachment systems, such as various types of expandable stents, is completely different from conventional graft replacement. The long-term durability of TPEG is not yet known, and therefore we must remain cautious in patient selection. The cause and morphology of each aortic aneurysm determine whether TPEG are indicated. At present, TPEG is used to treat patients with aneurysms below the distal arch, and infrarenal abdominal aorta. However, indications in patients with aortic dissections are not clearly defined, because though the procedure is technically feasible, the effectiveness is not yet known and further investigation is required.