Endovascular Aortic Aneurysm Repair Ñ Five Years Down the Road: Where to Now?

Aneurysm Repair — Five Years Down the Road: Where to Now?”, it is necessary to consider what has been achieved to date. Following the first report on the feasibility of endovascular repair of abdominal aortic aneurysms (AAA) by Parodi, et al. in 1991, we commenced a program using a modification of his method in May 1992. By the following year, White, et al. had developed a non-stented endograft and the first commercially produced endograft was available for clinical trials (Endovascular Technologies, Menlo Park, New Jers e y ) . , 4 The early prostheses required 24 Fr internal diameter introducing sheaths which were relatively inflexible. In general, they were anchored by metallic stents attached to the ends of the fabric grafts. Endografts were initially tubular in configuration and later aorto-uni-iliac and one-piece, bifurcated construction. Increasing clinical experience and improvements in technology led to the development of second generation devices. These used smaller diameters and more flexible introducing sheaths and consisted of fabric grafts supported throughout their length by a selfexpanding metal frame to minimize kinking and twisting. One-piece bifurcated endografts were replaced by modular ones. We present here our experience over a five and one-half year period and make some observations, on this basis, for the future direction of endovascular AAA repair.