Endovascular repair of aortic aneurysms, arteriovenous fistulas, and false aneurysms

The diagnosis of abdominal aortic aneurysms (AAA) has been established with increasing frequency during the past two decades. This is probably due to the aging of the population as well as to the extensive use of ultrasonography and computerized tomography (CT) scanning for different pathologies. Although AAA may occasionally cause distal embolization, rupture remains the most common and deadly complication. Elective replacement with a synthetic graft has proved to be the most appropriate method to prevent AAA rupture for nearly 40 years, and at respected medical centers, it has been associated with a postoperative mortality of less than 5%. Non-fatal complications occur with some regularity irrespective of the setting in which the operation is performed. Increasingly, vascular surgeons are encountering older patients with severe co-morbid conditions. This can increase operative morbidity and may even elevate mortality of aortic surgery to a figure in excess of 60%. It seems inevitable that every vascular surgeon will, with some frequency, encounter patients who represent a prohibitive risk for conventional graft replacement, yet alternative forms of treatment (such as axillofemoral bypass in conjunction with induced AAA thrombosis) generally have been abandoned despite preliminary reports of their initial success.