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Endovascular Repair of Aortic Aneurysm

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"It is not clearly understood why an arterial wall weakens and an aneurysm forms, but evidence shows that chemical or cellular degeneration, or an enzyme deficiency may be at work. Other risk factors include a family history of aneurysms as well as aging," explains Thomas Grabiak, MD, Virtua vascular surgeon.

"Abdominal aortic aneurysms are a common cause of death in elderly Caucasian men," says Virtua vascular surgeon, Ashish Bedi, MD. "Generally, an aortic aneurysm greater than five and a half centimeters requires repair, or there is a high risk of rupture with an ensuing 50 percent morbidity."

Before FDA-approval of endovascular stents in 1999, aortic aneurysm repair always meant open surgery with a 12-inch incision from under the breast bone to the top of the pubis. Dr. Grabiak: "We now can make these repairs using a delicate endovascular approach via the femoral artery."

The surgeon places an end graft, surrounded by a stent, into the aortic aneurysm site to relieve pressure on the aortic wall, and help decrease the likelihood that the aneurysm will rupture. Follow-up includes periodic CT scans to ensure that the endograft has not migrated, that there is no endovascular leak or enlargement of the aneurysm sac.

"The endovascular approach is best for patients age 70 or older who meet the anatomic criteria, or younger patients with preexisting conditions that prevent them from having open surgery, such as severe heart disease," explains Dr. Bedi.

The Endovascular Aneurysms Repair 1 trial (EVAR) demonstrates the efficacy of this repair. In it, subjects, all of whom were candidates for open surgery, were randomized to either an open procedure or an endovascular repair. After three years, the all-cause mortality was identical in the two groups. "Beyond this finding," adds Dr. Grabiak, "an endovascular approach also helps reduce the morbidity associated with an open procedure."

This Virtua Physician article was last updated: August 25, 2008