Endoprosthesis for aneurysm of the abdominal aorta: An innovating technology and a cultural revolution

Facts: A revolutionary technology has totally renovated the treatment of an eurysms of the abdominal aorta. Classical dissection-graft procedures requi re a wide abdominal incision with clamping and declamping times, and often major blood loss. Perioperative mortality varies from 3% to 7% depending on the team's experience and the presence of comorbidities. Complications occ ur in 30% of the patients; often benign they can be quite serious. As direc t consequence of the development of peripheral stents, endoprostheses can n ow be introduced via the femoral route through a short inguinal incision. O perative trauma is considerably reduced, greatly shortening the recovery ti me. Mortality is low, of around 1%, and postoperative complications are muc h less frequent and much less severe. There is also a 3-fold reduction in t he duration of the hospital stay. Prerequisites: All aneurysms cannot be treated with this method. The anatom y of the aneurysm and the iliac arteries is a determining factor. The iliac vessels must be large enough and devoid of important obstruction (kinks, a theromatous plaques) in order to access the aorta. The subrenal collar must measure at least 1 cm and be free of severe calcifications or thrombi. A r igorous preoperative exploration, using CT-scan with 3D reconstruction and graduated arteriography, is necessary. The length and diameter of the prost hesis is calculated from the results and must be perfectly adapted to avoid failure. Unknowns: Long-term outcome remains unknown. The endoprosthesis exclused th e aneurysm from the blood stream, depressurizing the aneurysmal sac. Endopr osthetic leakage can occur in case of defective application or by reflux fr om lumbar or inferior mesenteric arteries or due to leakage of the endopros thesis itself. In such cases, the aneurysm can continue to progress. This e xplains the need for careful follow-up with duplex Doppler and/or CT scan i n treated patients. If the treatment is incomplete, complementary procedure s may be necessary, often via an endovascular route or in some cases with c onversion to conventional surgery. Evaluations: Improved prosthetic design and durability is an important poin t. Randomized studies organized in France, as well as in England and Hollan d and the United States, are currently assessing the contribution of this n ew technique and its relative role compared with conventional surgery.