Endovascular sealing for abdominal aortic aneurysms: evolution or revolution?

Abstract

British Journal of Hospital Medicine, November 2013, Vol 74, No 11 611 © 2 01 3 M A H ea lth ca re L td wall apposition at the proximal and distal sealing zones. This necessitates a parallel length of artery – typically, infra-renal aortic neck and iliac artery – of good length and quality without significant thrombus, angulation or dilatation. Approximately 40% of infrarenal abdominal aortic aneurysms lack these features.’ Dr Holden concluded: ‘The prospect of a successful endovascular aneurysm sealing technology is exciting and potentially disruptive for current abdominal aortic aneurysm management.’ Stephen Pinn Long-term outcomes in the femoral-popliteal artery are best with drug-eluting balloons – but only just. Dr Konstantinos Katsanos of Guy’s and St Thomas’ NHS Foundation Trust, London, reported data from a meta-analysis of 16 randomized controlled trials comparing drug-eluting balloon, bare metal stents and drug-eluting stents with each other and with plain balloon angioplasty in the femoral-popliteal artery. This research involved 2547 patients with 4138 person-years of follow-up. Compared to plain balloon angioplasty, technical success was highest with nitinol-coated stents (risk ratio 2.3, probability being best 40%). Vascular restenosis was lowest with paclitaxel-eluting stents (risk ratio 0.41, probability being best 50%) followed by drug-eluting balloons (risk ratio 0.43, probability being best 41%). Dr Katsanos concluded: ‘Immediate technical success was highest with covered stents, whereas paclitaxel-eluting stents and paclitaxel-coated balloons offered the best long-term results in the femoralpopliteal artery.’ Stephen Pinn Drug-eluting balloons vs stents in the femoralpopliteal artery: a meta-analysis If durability can be achieved without significant secondary intervention, the current postendovascular aneurysm repair imaging surveillance protocol can be seriously altered with major cost savings. In a wide-ranging review of endovascular aneurysm sealing and repair, Dr Andrew Holden of Auckland City Hospital, New Zealand, asserted: ‘Patients could be discharged after endovascular aneurysm sealing without the need for surveillance or secondary intervention – and a revolution may have truly arrived.’ Dr Holden said that although the durability of endovascular aneurysm repair was a concern from the start, there was the expectation that such a minimally-invasive procedure, compared to open abdominal aortic aneurysm repair, would result in dramatically reduced morbidity and mortality. However, early registries reported disappointing and disturbing findings. He commented: ‘The reason that more patients cannot be treated by endovascular aneurysm repair is because almost all current devices seal the aneurysm from pressure and rupture risk is by graft–artery CardiovasCular and interventional radiologiCal soCiety oF europe; barCelona, spain, 14–18 september