Endovascular Repair of Abdominal and Thoracic Aortic Aneurysms

A ortic aneurysms remain a challenging problem for pa- tients and physicians.There have been major advances in the treatment of large-vessel aneurysms during the past 10 years.The surgical armamentarium used to treat these aneurysms now includes an endovascular approach that allows the insertion of a graft to exclude the aneurysm sac from blood flow.The endovascular repair of abdominal and thoracic aortic aneurysms has become a viable alternative to open repair and is often the approach of choice for high-risk patients.In this review, we examine the endovascular treatment of abdominal and thoracic aortic aneurysms. Endovascular Repair of Abdominal Aortic AneurysmsAbdominal aortic aneurysms (AAAs) are a formidable diagnosis for patients.This is a life-threatening condition that mandates consideration of repair.][3] There is, therefore, a clear advantage to treating these aneurysms before they rupture.Because this disease affects 4% to 7% of adults over the age of 65 years, with a far greater prevalence in males than females, clinicians will encounter this problem more frequently as the population ages. 4AAs usually develop in patients with a history of arteriosclerosis or smoking.Patients present for repair when it is discovered that there is a dilation of their abdominal aorta to a diameter 1.5 times normal.The result is a weakened aortic wall that is at increased risk of rupture.The pathogenesis of this aortic wall change likely involves enzymes responsible for elastin and collagen breakdown. 5Recent research has focused on the role of metalloproteinase-9 (MMP-9).Aneurysm presence and size have been correlated with MMP-9 levels.Other investigators are looking into the inflammatory and autoimmune mechanisms involved in aneurysmal disease. 6Another area of research is in the molecular genetics of AAAs, because these aneurysms have a well-recognized familial nature.There is also an interest in the analysis of aortic wall stress distribution from a biomechanical approach.Ongoing studies have found that peak wall stress can predict those patients who will experience AAA rupture. 7,8atients with symptomatic aneurysms should be offered repair, after careful consideration of comorbidities, even if From the Baptist Cardiac and Vascular Institute (B.