Devices for endovascular abdominal aortic aneurysm repair: Factors affecting stent graft selection

Minimally invasive endovascular techniques for the treatment of abdominal aortic aneurysms (AAA) have significantly reduced the morbidity of these procedures as compared with standard surgical repair. In addition, patients with extensive comorbid medical illnesses in whom standard operative repair is contraindicated may be successfully treated using endovascular means. A variety of endovascular stent grafts are currently being used clinically for endovascular AAA repair. The characteristics of these stent grafts vary significantly. In selecting the specific stent graft to be used for endovascular AAA repair, these specific characteristics must be considered, particularly with regard to the individual patient's anatomic and physiologic characteristics. In addition, the indications for use of endovascular grafts as compared with standard open surgery have not yet been fully defined. Endovascular stent grafts in current use have limitations, and their use must be tempered accordingly until their long-term effectiveness is more completely evaluated. This chapter describes the general principles of use for endovascular devices for the repair of AAAs. It details the features and results for the devices in current use and highlights the factors that influence the selection of specific stent-graft types.