Endovascular Aneurysm Sealing for Abdominal Aortic Aneurysm Repair: Evolution or Revolution?

Excerpt

When Juan Parodi, an Argentinian vascular surgeon, performed the first endovascular aneurysm repair (EVAR) in 1989 [1], the interventional world expected that a revolution in aneurysm repair would quickly follow. The idea of a percutaneously delivered endograft was predicted in 1969 by Charles Dotter and first reported in 1986 at the Radiological Society of North America by another American radiologist, Cesar Gianturco [2]. He used endografts in the tracheobronchial tree amongst other locations [3]. Parodi initially treated type A aneurysms with a surgical tube graft fixed only with a proximal stent. However, he quickly developed a technique to treat aneurysms extending to the aortic bifurcation, and even involving the iliac arteries, using an aorto-uni-iliac endograft with femoral–femoral cross-over (Fig. 1) [4]. During the next few years, pioneers around the world advanced the technologies and techniques, and early commercial endografts became available with most being fully supported by self-expanding stents. By 1993, methods to reconstruct the aorta with a bifurcated endograft were being developed: The most effective involved a graft body with a short and a long limb with the short limb being cannulated and extended from the contralateral femoral artery.

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