Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm (AAA)

Abdominal aortic aneurysms (AAAs) are common in the industrialised world, causing 2% of all male deaths over 55 years of age, with a male to female ratio of 4:1. Risk factors are essentially those of atherosclerosis (tobacco use, hypertension, male sex and a family history of AAA). Rarer causes of aneurysms include infection, trauma, arteritis and connective tissue disorders such as Marfan's and Ehlers-Danlos syndrome. Treatment has traditionally been surgical, performed for over 50 years via laparotomy, by clamping the aorta above and below the aneurysm, and anastamosing a tubular inlay graft to the normal calibre artery above and below the aneurysm, thus excluding it from the circulation. Operative mortality of this procedure in the emergency setting is in excess of 50%. Mortality is greater than 99% in the event of peri-operative cardiac arrest. Mortality associated with elective AAA repair is just under 5%. Juan Carlos Parodi pioneered the endovascular approach to infrarenal aneurysm exclusion in Argentina, publishing a series of five patients (deemed anaesthetically unfit for open surgery) whom he had successfully treated via a femoral endovascular approach in 1991. Perhaps due to the wide familiarity and acceptance of the open operation, its conceptual simplicity and on-going role, the technique of EVAR met initial resistance; how-ever, during the intervening 15 years, significant advances have been made. An endoluminal approach to exclude aortic aneurysms is now becoming increasingly common in the UK, predicated upon the two-thirds' reduction in 30-day mortality compared to open repair. Patients are increasingly aware of the technique and the widely publicised EVAR 1 Trial demonstrating the decreased 30-day mortality (from 4.7% with the open technique to 1.7% using EVAR).