Aortic Aneurysm Repair using the Aortic “Endograft” (Stent Graft)

In 1991, the first aortic aneurysm repair using an aortic endograft was reported. With this technique, a fabric covered metallic stent or “endograft” is inserted into an abdominal aortic aneurysm without making an incision on the abdomen. The endograft is placed within the abdominal aortic aneurysm by making an incision in the femoral artery at the level of the groin and passing the device into the aneurysm while watching its progress through the arterial system on an x-ray monitor. When the device is seated properly within the aortic aneurysm, the “endograft” is released from the introducer device and stays within the aneurysm to protect it from rupture.

The interval between 1991 and 1999 was a time of testing and refining of the aortic endografts. Several "Trials" using various devices were undertaken by leading vascular specialists throughout the world. In November of 1999, the Food and Drug Administration (FDA) approved two endografts for human use in the United States. One of these devices was manufactured by the Guidant Corporation and the other by the Medtronics Corporation. Approval of other endograft devices produced by the Gore and Cook Corporations followed a few years later. 

The obvious advantage of the aortic endograft is that no abdominal incision is required. Recovery from the operation is considerably shorter than with traditional (open) aortic aneurysm surgery.

Follow-up data after placement of the aortic endograft is currently in the range of seven years and the early results with regard to prevention of aneurysm rupture are quite good.  This length of follow-up is relatively short compared to what we know about traditional (open) aneurysm repair.  For this reason, close follow-up of patients who have undergone endograft aortic aneurysm repair is advised to ascertain that these devices will remain effective in preventing aneurysm rupture many years after implantation.  Follow-up by the patient’s surgeon on a regular basis (at least once or twice a year) and regular examination with an ultrasound and/or CT scan study is recommended by most vascular surgeons.  

It is important to emphasize that not everyone is a candidate for placement of the endograft device. There are certain stringent anatomical criteria that must be met to allow for successful deployment of this device. The size of the normal aorta above the aneurysm and the size of the iliac and femoral arteries below the aneurysm are crucial for successful placement of the device. If the arteries leading to the legs (iliac arteries) are too small or too atherosclerotic, it is not possible to pass the device up the leg artery and into the aneurysm. If the aorta above the aneurysm is too large, the device will not stay in place and may move out of its intended location.

The advisability of using the endograft surgical repair or the traditional (open) aortic aneurysm surgery can only be determined by the vascular surgeon after review of the CT scans and all other diagnostic data. The patient should seek advice from a certified vascular surgeon who is trained to perform both the open and the endograft surgery so that the most balanced opinion can be obtained.

Comparison of the Traditional (Open) Aneurysm Repair and
Endograft Repair

Aneurysm with
Aortic stent in place