Key result
A systematic review found no randomized or controlled clinical trials comparing the post-procedural outcomes of PTFE versus polyester stent-grafts in endovascular abdominal aortic aneurysm repair.
Why the study?
Endovascular aneurysm repair faces concerns over secondary interventions, but there has been no objective comparison of post-procedural outcomes between PTFE and polyester stent-graft materials.
Does endovascular repair with a polyester-based endograft compared to a PTFE-based endograft improve outcomes in patients with primary abdominal aortic aneurysms undergoing EVAR?
Systematic Review
Does endovascular repair with a polyester-based endograft compared to a PTFE-based endograft improve outcomes in patients with primary abdominal aortic aneurysms undergoing EVAR?
There is a complete lack of randomized controlled trial evidence comparing PTFE and polyester stent-graft materials for endovascular abdominal aortic aneurysm repair, highlighting a critical gap in the literature.
Stent-graft material choice in EVAR remains unguided by direct evidence; leaves open need for randomized comparisons.
Endovascular aneurysm repair of the abdominal aorta (EVAR) and of the thoracic aorta (TEVAR) have revolutionised therapeutic strategies in the management of aortic pathology, and endovascular repair is now an established and attractive alternative to open surgical repair (OSR) due to its superior short-term safety profile. However, opinions are divided regarding its long-term cost-effectiveness, which is reflected in the controversial NICE guidelines on abdominal aortic aneurysm (AAA) repair published in 2018, which advised against EVAR for elective aortic repair due to high secondary intervention rates and resultant associated costs. There is no doubt that OSR continues to have a valuable role to play in aortic repair, but it is not universally applicable, especially in older and sicker patients. Therefore, we should not dismiss EVAR and TEVAR without examining the reasons for long-term failure, and the most obvious starting point is stent graft material properties. Polytetrafluoroethylene (PTFE) and polyester are the two most common stent-graft materials; however, there has been no objective comparison of PTFE and polyester stent-graft post-procedural outcomes in EVAR and TEVAR, or even OSR. This lack of definitive data on different stent-graft materials and their configuration necessitates a comprehensive review to elucidate the post-procedural outcome in terms of endograft failure, cardiovascular events, and aortic-related mortality and morbidity.
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Hynes et al. (2022) conducted a systematic review in Abdominal Aortic Aneurysm (AAA). PTFE stent-graft vs. Polyester stent-graft was evaluated on Aneurysm-related death and major adverse cardiovascular events. A systematic review found no randomized or controlled clinical trials comparing the post-procedural outcomes of PTFE versus polyester stent-grafts in endovascular abdominal aortic aneurysm repair.
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