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Identifying and addressing the limitations of EVAR technology
Viony M Belvroy1, Ignas B Houben2, Santi Trimarchi1
1a Department of Vascular Surgery II , Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan , Milan , Italy.
Expert Review of Medical Devices
|July 31, 2018
Summary
Endovascular aortic repair (EVAR) offers lower early mortality for abdominal aortic aneurysms (AAA) but requires careful consideration of reintervention rates and long-term device durability. Ongoing technological advancements aim to address these limitations.
Area of Science:
- Vascular Surgery
- Medical Technology
- Aortic Aneurysm Treatment
Background:
- Endovascular aortic repair (EVAR) is now the primary treatment for approximately 80% of abdominal aortic aneurysm (AAA) patients.
- EVAR has evolved significantly over the past two decades, improving patient outcomes.
Purpose of the Study:
- To review the differences between endovascular and open aortic repair.
- To discuss clinical characteristics, imaging, and technological developments in EVAR.
- To highlight current limitations and future directions in EVAR technology.
Main Methods:
- Comparative analysis of endovascular versus open aortic repair.
- Review of clinical imaging's role in EVAR suitability.
- Discussion of technological advancements in endovascular devices.
Main Results:
- EVAR demonstrates lower early mortality compared to open repair, though this advantage diminishes after three years.
- A significant reintervention rate is associated with EVAR, with endoleak being a primary predictor.
- Advanced EVAR techniques now accommodate challenging patient anatomies.
Conclusions:
- While EVAR technology has advanced, long-term device durability in dynamic human anatomy remains a critical concern.
- Future focus should address the limitations of current EVAR devices to improve long-term outcomes.
- Continued innovation is needed to overcome the inherent challenges of endovascular aneurysm repair.
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