Late Failures of Devices Used for Endovascular Treatment of Abdominal Aortic Aneurysm: What Have We Learned and What is the Task for the Future?

-Since their introduction in 1991, endografts for the exclusion of abdominal aortic aneurysms have evolved by "learning from failures." As significant device failure modes are reported, manufacturers modify device design to improve effectiveness and durability based on analysis of clinical results. This article summarizes what has been learned from a variety of device failures with a view toward understanding the implications for future activity in the continuing development of endovascular technology. Secondary interventions have been used to improve late outcomes of many devices. Long-term durability remains an issue because the limited data on follow-up beyond 3 or 4 years show gradually accumulating device failures in ways that were not anticipated. The future of successful endografting requires more and longer-term follow-up data, better understanding of the interaction between aortoiliac morphology and device design, improved imaging techniques, development of physiologic methods for endograft assessment, investigation of adjunctive measures to control the abdominal aortic aneurysm (AAA) sac environment, and expansion of the dialogue between clinicians and industry. KEYWORD Abdominal aortic aneurysm - endograft failure - stent-graft durability