Explain the concept of endovascular aortic repair

Explain the concept of endovascular aortic repair.

Endovascular aortic repair is a new alternative to conventional surgical repair of aortic pathology. Endovascular grafts are less invasive compared with conventional arterial reconstruction. They are inserted through small incisions from remote arterial access sites. This technique obviates the need for aortic occlusion, decreases blood loss, avoids significant fluid shifts that occur with visceral manipulation, thus lowering the risk of significant hemodynamic changes perioperatively, and prevents respiratory impairment from abdominal incisions.

Because of the uncertainty of long-term outcome, younger patients with minimal or no medical comorbidities may be better candidates for open repair because of its established track record. Patients with severe medical comorbidities may be better candidates for endovascular reconstruction. Not all patients with aortic pathology have suitable anatomy for endovascular repair. In order for an endovascular repair to be successful, the device must form a tight seal between the graft and the native artery. The proximal neck (i.e., proximal “landing zone”) must be at least 15 mm in length and the aneurysm neck diameter should be no larger than the largest endograft available. Similarly, the distal attachment site must be non-aneurysmal and of sufficient length to accommodate the graft. No important aortic side branches, such as an accessory renal artery or inferior mesenteric artery, can be present in the aortic segment that is to be excluded. In practice, excessive aneurysm neck tortuosity, severe calcification, aneurysmal necks greater than 26–27 mm in diameter and less than 10–15 mm in length may be relative contraindications for endovascular repair. Finally there must be at least one large, straight iliac artery that can accommodate passage (i.e., act as a conduit) of the endograft delivery system.