Assessing the effectiveness of endografts: Clinical and experimental perspectives

The increasing use of endografts to treat abdominal aortic aneurysms has prompted the need for improved postoperative imaging and surveillance. Although patients benefit from decreased morbidity with endovascular repair compared with open abdominal aortic aneurysm repair, the long-term outcome of st...

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Bibliographic Details
Published in:Journal of vascular surgery 2007-06, Vol.45 (6), p.A123-A130
Main Authors: Lee, Larisse K., MD, Faries, Peter L., MD
Format: Article
Language:English
Subjects:
Angiography, Digital Subtraction
Animals
Aortic Aneurysm, Abdominal - pathology
Aortic Aneurysm, Abdominal - surgery
Aortography - methods
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation - instrumentation
Diagnostic Imaging - methods
Disease Models, Animal
Foreign-Body Migration - diagnosis
Humans
Imaging, Three-Dimensional
Magnetic Resonance Angiography
Magnetic Resonance Imaging, Cine
Postoperative Care
Postoperative Complications - diagnosis
Predictive Value of Tests
Prosthesis Design
Prosthesis Failure
Sensitivity and Specificity
Stents
Surgery
Thrombosis - diagnosis
Tomography, X-Ray Computed
Treatment Outcome
Ultrasonography, Doppler, Duplex
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Summary:The increasing use of endografts to treat abdominal aortic aneurysms has prompted the need for improved postoperative imaging and surveillance. Although patients benefit from decreased morbidity with endovascular repair compared with open abdominal aortic aneurysm repair, the long-term outcome of stent repair has yet to be fully determined. The persistence of endoleaks highlights the need for close follow-up, particularly because this may lead to aneurysm rupture, even after endograft repair. The current mainstay of assessing the healing of endografts is obtaining serial helical computed tomography angiography (CTA) to identify endoleaks, graft migration, thrombosis, and structural failure. CTA is not completely effective at identifying endoleaks and predicting aneurysm rupture, however. Other modalities have been studied to improve on current imaging methods, including three-dimensional CTA with volumetric analysis, contrast-enhanced duplex ultrasound imaging, cine magnetic resonance angiography, and explant analysis. In vitro and large-animal models of abdominal aortic aneurysm have also been developed to study the pathophysiology and treatment response of aneurysm exclusion. Thus, clinical and experimental models of endograft healing are attempting to define the optimal method of postoperative surveillance of endovascular repair.
ISSN:0741-5214
1097-6809
DOI:10.1016/j.jvs.2007.02.047