Endovascular aneurysm repair: the indications widen

Recently, the material available for endovascular aneurysm repair (covered stents and application systems), real time medical imaging and operator exp erience have significantly improved. Hence, more and more complex vascular lesions, well beyond the original indications, can now be treated by endova scular surgery. Since 1996 our group has implanted 55 endovascular systems in the clinical setting: 45/55 (80%) for classical indications and 11/55 (2 0%) for extended indications. In the latter group four different endoprosth etic systems were used according to either their performance and availabili ty or the type of lesion to be treated. For the 11 patients undergoing endo vascular procedures with extended indications, 6/11 had thoracic aortic les ions (55%) and 5/11 (45%) had aorto-iliac lesions requiring either progress ive embolisation of the internal iliac arteries or suprarenal anchorage. Fo r these extended indications hospital mortality was 0/11 (0%). One patient died after hospital discharge. 1/11 patients (9%) had to be converted to op en surgery during the interval between iliac embolisation and endovascular repair. There has been no conversion to open surgery during or after the en dovascular procedures. Two major endoleaks were detected (2/11: 18%). One h as been corrected by an additional covered stent and endovascular repair is planned for the other one. Spontaneously regressive functional hypoperfusi on has been observed in 4/5 patients with progressive internal iliac emboli sation. There was no irreversible renal insufficiency. Early results of end ovascular aneurysm repair for extended indications are promising. Although the longterm outcome is unknown, it can already be said that traditional op en surgery can be avoided for a considerable amount of time in an increasin g number of patients.