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endovascular graft (endovascular repair)

Indications: - repair of abdominal aortic aneurysm (AAA) - repair of other large artery aneurysms Procedure: - for AAA, the graft is inserted percutaneously through the femoral artery Complications: 1) 30 day mortality is (1.8-4.4%) 2) 5 year freedom from aneurysmal-related death is 84% (overall 5 year survival is 36-48%; most deaths related to other causes) 3) less short-term morbidity & mortality than open repair 4) 2-year survival no better than open repair & is more costly [3,4] 5) frequently requires additional graph-related interventions during immediate-term follow-up a) 6.7% conversion to open repair [5] b) 21.8% reintervention (for example, endovascular procedure to correct graph-related endoleak) Clinical trials: - see Endovascular Aneurysm Repair trial Management: - prophylaxis for bacterial endocarditis (aortic prosthesis) - prior to dental procedure involving manipulation of gingival or periapical region of teeth or perforation of oral mucosa - not recommended before respiratory tract procedures, GI or GU procedures, or dermatologic or musculoskeletal procedures unless patient in immunocompromised Notes: - 2-5 year survival similar to open repair of AAA [8]

Related

abdominal aortic aneurysm (AAA) aortic prosthesis Endovascular Aneurysm Repair (EVAR) trial

Specific

endovascular graft abdominal aorta endovascular graft descending thoracic aorta endovascular graft iliac artery

General

vascular surgery tissue graft

References

  1. Journal Watch 21(20):161, 2001 Ohki et al, Ann Surg 234:323, 2001
  2. Journal Watch 24(8):61-62, 2004 Lee WA et al Perioperative outcomes after open and endovascular repair of intact abdominal aortic aneurysms in the United States during 2001. J Vasc Surg 39:491, 2004 PMID: 14981436 - Elkouri S et al, Perioperative complications and early outcome after endovascular and open surgical repair of abdominal aortic aneurysms. J Vasc Surg 39:497, 2004 PMID: 14981437 - Minor ME et al, Endovascular aortic aneurysm repair in the octogenarian: is it worthwhile? Arch Surg 139:308, 2004 PMID: 15006890
  3. Journal Watch 25(14):113, 2005 Blankensteijn JD, de Jong SE, Prinssen M, van der Ham AC, Buth J, van Sterkenburg SM, Verhagen HJ, Buskens E, Grobbee DE; Dutch Randomized Endovascular Aneurysm Management (DREAM) Trial Group. Two-year outcomes after conventional or endovascular repair of abdominal aortic aneurysms. N Engl J Med. 2005 Jun 9;352(23):2398-405. PMID: 15944424 - Lederle FA. Endovascular repair of abdominal aortic aneurysm--round two. N Engl J Med. 2005 Jun 9;352(23):2443-5. No abstract available. PMID: 15944430
  4. Journal Watch 25(15):123, 2005 - EVAR trial participants. Endovascular aneurysm repair and outcome in patients unfit for open repair of abdominal aortic aneurysm (EVAR trial 2): randomised controlled trial. Lancet. 2005 Jun 25;365(9478):2187-92. PMID: 15978926 - EVAR trial participants. Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): randomised controlled trial. Lancet. 2005 Jun 25;365(9478):2179-86. PMID: 15978925
  5. Brewster DC et al, Long-term outcomes after endovascular abdominal aortic aneurysm repair: The first decade. Ann Surg 2006, 244:426 PMID: 16926569
  6. United Kingdom EVAR Trial Investigators, Greenhalgh RM, Brown LC, at al. Endovascular versus open repair of abdominal aortic aneurysm. N Engl J Med 2010 May 20; 362(20):1863-1871 PMID: 20382983
  7. De Bruin JL, Baas AF, Buth J, et al; DREAM Study Group. Long-term outcome of open or endovascular repair of abdominal aortic aneurysm. N Engl J Med 2010 May 20; 362(20):1881-1889 PMID: 20484396
  8. Jackson RS et al. Comparison of long-term survival after open vs endovascular repair of intact abdominal aortic aneurysm among Medicare beneficiaries. JAMA 2012 Apr 18; 307:1621 PMID: 22511690