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A 20 Year Experience with Endovascular Repair of Abdominal Aortic Aneurysms: A Record of the Development and Evolution of Techniques, Devices and Strategies
Rami O. Tadros, MD, Peter L. Faries, MD, Hannah L. Lowe, MD, Rachel Schrier, MD, Robert A. Lookstein, MD, Sung Yup P. Kim, MD, Jamie Kim, MD, Ageliki G. Vouyouka, MD, Sharif H. Ellozy, MD, Michael L. Marin, MD
The Mount Sinai School of Medicine, New York, NY, USA.
OBJECTIVES:
Endovascular repair of abdominal aortic aneurysms (EVAR) has become the first line treatment of abdominal aortic aneurysms (AAA) worldwide. Since the first successful EVAR in North America, the authors have maintained a continuous, prospective database recording the details of each procedure.
METHODS:
1268 patients underwent EVAR for repair of AAA between 1992-2012. 15 different types of stent grafts were employed (Table 1). The mean age was 75 years and 85% were men. 81% exhibited high risk characteristics that would preclude participation in FDA-mandated, Industry Sponsored-IDE pivotal trials. 93% of patients had at least 1 severe comorbid medical condition with an average of 2.2 conditions/patient. During EVAR 38% had concomitant treatment of associated common iliac artery aneurysms. Mean follow up was 38.2 months.
RESULTS:
Major perioperative complications occurred in 7.5% with a perioperative mortality rate of 2.5%. Aneurysm size remained stable or decreased (>5mm) in 86.5% of patients; increased (>5mm) in 13.5%; median time to aneurysm expansion was 8.2 years. During follow up, 2.1% of patients experienced type I endoleak and 0.2% exhibited type III. Reintervention was required in 21% of patients. Mean time to reintervention was 26 months. Freedom from aneurysm related mortality was 91.1% at 12 years. The median survival for all-cause mortality was 5.6 years.
CONCLUSIONS:
Progressive advances in EVAR allow safe, effective and durable repair of AAA, extending the IFU parameters of commercially available-devices. 
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