What do we need to know to achieve durable endoluminal abdominal aortic aneurysm repair?

The exclusion of abdominal aortic aneurysms with endoluminal grafts is in its earliest stages, and the technology is in continuous transition. While results with 1st-generation devices have been somewhat discouraging in some cases, lessons learned from these initial attempts have led to considerable improvement in device design and deployment techniques. Lower-profile devices that are smaller and more flexible have made implantation less traumatic, and the incidence of endoleak formation has been reduced to 10% or less in some series. A modified percutaneous approach has also been introduced, and it may reduce the need for open exposure of the femoral artery in endoluminal graft procedures. Treating aneurysm expansion earlier, perhaps at 4 cm, may allow use of simpler, straight-tube prostheses and prevent problems associated with the use of larger, bifurcated endoluminal grafts. Numerous endoluminal graft designs are being tested, including both internally and externally covered prostheses. The success with a covered device may depend upon the type of material used and the extent to which it covers the endoluminal graft; fabric covering over a completely metal structure may allow a high degree of perioperative success and improvement in late outcome. The use of "hooks" to anchor or stabilize the endoluminal graft is also under study but is still controversial. The expense associated with endoluminal graft technology is currently high; therefore, it is likely that cost savings will be the result of shorter hospitalizations, little or no time spent in the intensive care unit, and fewer pre- and postoperative tests.