STENT GRAFTS FOR AORTIC-ANEURYSMS - THE NEXT INTERVENTIONAL CHALLENGE

Stent grafts (endografts) have proved useful for the endoluminal exclu sion of peripheral and aortic aneurysms, both those in native arteries and those resulting from prior surgery. In addition, their use may ap ply in some patients with occlusive vascular disease. Various types of endografts are being evaluated in clinical trials, including those th at utilize unsupported grafts with stent-like attachment mechanisms an d those having a metallic endoskeleton or exoskeleton. Relatively comp lex devices can be delivered through small arteriotomies and in some c ases percutaneous approaches. Unsupported grafts, although more prone to kinking and incomplete expansion, appear to work well. Some devices employ modularity, which involves separate placement of contralateral limbs and, in some cases, extension devices. For performing endovascu lar grafting, pretreatment planning is critical and requires sophistic ated imaging, including spiral computed tomography (CT) with 3-dimensi onal reconstruction and angiographic evaluation using catheters with c alibrated markers. Potential advantages of endovascular grafts include a decreased hospital stay, a less invasive procedure, and lower morbi dity and mortality. Several issues remain unresolved and should be add ressed by the newer generation of these devices. (C) 1998 by Excerpta Medica, Inc.