Endovascular aneurysm repair: current and future status.

Area of Science:

• Vascular Surgery
• Medical Device Technology
• Interventional Cardiology

Background:

• Endovascular aneurysm repair (EVAR) has seen rapid expansion since the early 1990s.
• Initial EVAR experiences were marked by high complication rates, including conversion to open repair.
• While perioperative outcomes have improved, long-term durability remains a significant concern.

Purpose of the Study:

• To outline current concepts in endovascular aneurysm surgery.
• To discuss the controversies and challenges in the field.
• To explore the future directions of EVAR, particularly with advanced technologies.

Main Methods:

• Review of historical data and current literature on endovascular aneurysm repair.
• Discussion of emerging fenestrated and branch stent-graft technologies.
• Analysis of clinical challenges and controversies in EVAR.

Main Results:

• EVAR techniques have progressed, with improved perioperative morbidity and mortality.
• Long-term durability concerns are gradually being addressed.
• Current challenges involve extending EVAR to patients with adverse aneurysm morphology.

Conclusions:

• Fenestrated and branch stent-graft technology is nascent, with ongoing research into its benefits and risks.
• Understanding the advantages, limitations, and complications of new technologies is crucial.
• The future of endovascular aneurysm surgery involves overcoming challenges in complex anatomies and ensuring long-term device performance.