Abdominal Aneurysms: Endovascular Aneurysm Repair

Key Points
• Endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms offers an important new alternative to open surgical procedure.
• Compared with conventional open surgery, EVAR reduces operating time, blood transfusions, intensive care requirements, and length of hospital stay.
• Perioperative mortality rates after EVAR in asymptomatic abdominal aortic aneurysms in the randomized trials is between 1.2% and 1.7%.
• The perioperative survival advantage with endovascular repair as compared with open repair is not sustained after the first year.
• Long-term reports are not available, but midterm follow-up of EVAR reveals a higher incidence of reinterventions compared to open surgical repair.
• The perplexing problems of endoleaks and graft failure continue to be challenges that technological innovations must address.
• Until solutions for endoleaks, endotension, and stent failure are found, EVAR remains an imperfect long-term treatment and requires regular, lifelong graft surveillance.
• Based on the available evidence, EVAR is an appropriate treatment for selected patients.