[Endovascular graft treatment of aortic aneurysms: future perspectives]

Endovascular graft treatment of aortic aneurysms, first clinically applied by Parodi et al., has gained popularity. Although it was initially limited to high-risk patients, its indications have been gradually expanded. From literature and our own experience, the future of this method is discussed. The concept of this method is to place the intravascular stent graft in the aneurysm, excluding the aneurysmal sac and maintaining the arterial blood flow, thus preventing further dilatation and possible rupture in the future. However, these were some cases in which aneurysms, excluded completely during surgery became patent due to endoleak years after the procedure. A prospective study of abdominal aortic aneurysms, which compared endovascular graft and conventional open repair, demonstrated less major morbidity with the former but no difference in mortality, Considering those and the fact that long-term results of conventional surgical treatment have been satisfactory, the current indications for stent grafting should be limited to high-risk patients. For thoracic aortic aneurysms, endovascular treatment may become a useful alternative for those with localized as well as dissecting aneurysms because of the high perioperative morbidity accompanying conventional open repair. In summary, most patients with aortic aneurysms are senile and may have concomitant multiple organ failure. Less invasive, intravascular stent grafting has a definite role in the management of some patients with aortic aneurysms.