[EVAR for aortic abdominal aneurysms: A 20-year's experience of 1900 patients]

Abdominal aortic aneurysms (AAA), also called "silent killer" as they grow without symptoms until the final rupture, are the 3rd cause of cardiovascular deaths, after myocardial infarction and stroke. Surgery is the only efficient way of preventing aortic rupture. The initial technique, described by Charles Dubost in 1952 has evolved and results and provides fair long-term results: open repair (OR) is performed under general anesthesia, via a transperitoneal or a retroperitoneal approach. Laparoscopic repair aims to reduce the consequences of surgery, but its role is still debated due to limited experience and to variable results. Since initial reports by Volodos, and Parodi of endovascular aortic repair (EVAR) in 1993, there have been continuous technological improvements, initiated by Claude Mialhe's "modular" and "bifurcated" concepts. More recently, novel techniques and new devices have contributed to the widening of EVAR indications. In this article, we describe 20 years of our EVAR experience.