endovascular graft (endovascular repair)
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Indications
- repair of abdominal aortic aneurysm (AAA)
- repair of other large artery aneurysms
Procedure
- for AAA, the graft is inserted percutaneously through the femoral artery
Complications
- 30 day mortality is (1.8-4.4%)
- 5 year freedom from aneurysmal-related death is 84% (overall 5 year survival is 36-48%; most deaths related to other causes)
- less short-term morbidity & mortality than open repair
- 2-year survival no better than open repair & is more costly[3][4]
- frequently requires additional graph-related interventions during immediate-term follow-up
- 6.7% conversion to open repair[5]
- 21.8% reintervention (for example, endovascular procedure to correct graph-related endoleak)
Management
- prophylaxis for bacterial endocarditis (aortic prosthesis)
- prior to dental procedure involving manipulation of gingival or periapical region of teeth or perforation of oral mucosa
- not recommended before respiratory tract procedures, GI or GU procedures, or dermatologic or musculoskeletal procedures unless patient in immunocompromised
Clinical trials
- see Endovascular Aneurysm Repair trial
Notes
- 2-5 year survival similar to open repair of AAA[8]
More general terms
More specific terms
- endovascular graft abdominal aorta
- endovascular graft descending thoracic aorta
- endovascular graft iliac artery
Additional terms
References
- ↑ Journal Watch 21(20):161, 2001 Ohki et al, Ann Surg 234:323, 2001
- ↑ Journal Watch 24(8):61-62, 2004 Lee WA et al Perioperative outcomes after open and endovascular repair of intact abdominal aortic aneurysms in the United States during 2001. J Vasc Surg 39:491, 2004 PMID: https://www.ncbi.nlm.nih.gov/pubmed/14981436
Elkouri S et al, Perioperative complications and early outcome after endovascular and open surgical repair of abdominal aortic aneurysms. J Vasc Surg 39:497, 2004 PMID: https://www.ncbi.nlm.nih.gov/pubmed/14981437
Minor ME et al, Endovascular aortic aneurysm repair in the octogenarian: is it worthwhile? Arch Surg 139:308, 2004 PMID: https://www.ncbi.nlm.nih.gov/pubmed/15006890 - ↑ 3.0 3.1 Journal Watch 25(14):113, 2005 Blankensteijn JD, de Jong SE, Prinssen M, van der Ham AC, Buth J, van Sterkenburg SM, Verhagen HJ, Buskens E, Grobbee DE; Dutch Randomized Endovascular Aneurysm Management (DREAM) Trial Group. Two-year outcomes after conventional or endovascular repair of abdominal aortic aneurysms. N Engl J Med. 2005 Jun 9;352(23):2398-405. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15944424
Lederle FA. Endovascular repair of abdominal aortic aneurysm--round two. N Engl J Med. 2005 Jun 9;352(23):2443-5. No abstract available. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15944430 - ↑ 4.0 4.1 Journal Watch 25(15):123, 2005
EVAR trial participants. Endovascular aneurysm repair and outcome in patients unfit for open repair of abdominal aortic aneurysm (EVAR trial 2): randomised controlled trial. Lancet. 2005 Jun 25;365(9478):2187-92. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15978926
EVAR trial participants. Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): randomised controlled trial. Lancet. 2005 Jun 25;365(9478):2179-86. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15978925 - ↑ 5.0 5.1 Brewster DC et al, Long-term outcomes after endovascular abdominal aortic aneurysm repair: The first decade. Ann Surg 2006, 244:426 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16926569
- ↑ United Kingdom EVAR Trial Investigators, Greenhalgh RM, Brown LC, at al. Endovascular versus open repair of abdominal aortic aneurysm. N Engl J Med 2010 May 20; 362(20):1863-1871 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20382983
- ↑ De Bruin JL, Baas AF, Buth J, et al; DREAM Study Group. Long-term outcome of open or endovascular repair of abdominal aortic aneurysm. N Engl J Med 2010 May 20; 362(20):1881-1889 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20484396
- ↑ 8.0 8.1 Jackson RS et al. Comparison of long-term survival after open vs endovascular repair of intact abdominal aortic aneurysm among Medicare beneficiaries. JAMA 2012 Apr 18; 307:1621 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22511690