IN PERSPECTIVE - ENDOLUMINAL GRAFTING .1. WHAT DO WE NEED TO KNOW TO ACHIEVE DURABLE ENDOLUMINAL ABDOMINAL AORTIC-ANEURYSM REPAIR

The exclusion of abdominal aortic aneurysms with endoluminal grafts is in its earliest stages, and the technology is in continuous transitio n. While results with 1st-generation devices have been somewhat discou raging in some cases, lessons learned from these initial attempts have led to considerable improvement in device design and deployment techn iques. Lower-profile devices that are smaller and more flexible have m ade implantation less traumatic, and the incidence of endoleak formati on has been reduced to 10% or less in some series. A modified percutan eous approach has also been introduced, and ii may reduce the need for open exposure of the femoral artery in endoluminal graft procedures. Treating aneurysm expansion earlier, perhaps at 4 cm, may allow use of simpler straight-tube prostheses and prevent problems associated with the use of larger, bifurcated endoluminal grafts. Numerous endolumina l graft designs are being tested, including both internally and extern ally covered prostheses. The success with a covered device may depend upon ?he type of material used and the extent to which it covers the e ndoluminal graft; fabric covering over a completely metal structure ma y allow a high degree of perioperative success and improvement in late outcome. The use of ''hooks'' To anchor or stabilize the endoluminal graft is also under study but is still controversial. The expense asso ciated with endoluminal graft technology is currently high; therefore, it is likely that cost savings will be the result of shorter hospital izations,little or no time spent in the intensive care unit, and fewer pre-and postoperative tests.