[Endovascular reconstruction of infrarenal abdominal aortic aneurysm]

Animal experiments in the 80's demonstrated the feasibility of the concept first inaugurated by Dotter in 1969 of the endovascular implantation of a stent-graft prosthesis for the treatment of abdominal aortic aneurysm. In September 1990 Parodi was the first to treat a patient with an AAA using the implantation of a TPEG (transluminal placed endovascular stented graft). The rapid development of a variety of different devices can be observed since resulting in about 400 such prosthesis being implanted world wide for the treatment of AAA. The experience accumulated so far shows that severe complications can be avoided if morphology-based criteria are considered for the various treatment options (AAA classification type I, type IIa-c, type III). Despite considerable lethal incidents, technical mishaps and severe complications to date, the potential of TPEG for a structured approach to the treatment of AAA has to be evaluated. Prerequisites are 1) a competent team based on a close mutual cooperation of vascular surgeons and interventional radiologists, 2) a careful selection of patients, 3) TPEG to be performed in especially equipped operation theatres permitting the immediate application of conventional surgery if necessary, and 4) the implantation to be performed as a clinical study with flawless documentation of the procedure and follow-up.