Endovascular Treatment of Infrarenal Aortic Aneurysms

Abstract

The first open infrarenal abdominal aortic aneurysm (AAA) repair was performed in l951. Dubost replaced the AAA with a thoracic aortic homograft harvested from a recently deceased 20 year old. He performed a proximal end-to-end anastomosis, and a distal right Common Iliac Artery (CIA) end-to-end anastomosis, and then an end-to-side anastomosis after an endarterectomy on an occluded L CIA in a patient who went on to live for another 8 years. The first use of synthetic material for repair of aneurysms was by Blakemore and Voorhees in l954. They repaired 17 aortic aneurysms with Vinyon “N” cloth grafts. Open technique remained standard until the development of Endovascular Abdominal Aneurysm Repair (EVAR). In 1991, Parodi et al. performed the first EVAR in Argentina and in 1992 Parodi and Marin et al. performed the first EVAR in the USA (Fig. 22.1). Since then there has been tremendous development in stent-grafts, endovascular techniques, and management of complications which has allowed for EVAR to become the most common approach for AAA repair. Open repair is presently used mostly in patients who, for any of a variety of factors, are not candidates for endovascular repair. As technology advances the percentage of patients who undergo open repair is likely to become increasingly smaller.