Treatment Selection & Results

Treatment Selection & Results in Vascular and Endovascular Surgery


I had the privilege of placing the first commercially fabricated stent graft for repair of abdominal aortic aneurysm(AAA) in February of 1993. This investigational graft, manufactured by Endovascular Technologies(EVT) had a tubular configuration. In September of 1994 we repeated a “first” with the placement of an EVT bifurcated graft. Since then, the vascular surgery division at UCLA medical center has continued to be a leader in the clinical evaluation and endovascular repair of aortic aneurysm(EVAR). Now with over 17 years of experience with this technique, we can clearly state that this is the procedure of choice for most patients with AAA. The advantages of EVAR include its less invasive character. Two small incisions are made over the femoral arteries in the groin. Patients usually spend only one night in a regular hospital room instead of an ICU. There is virtually no blood loss, and the recovery is quick with a rapid return to work or normal daily activities. The mortality and complication rates are minimal compared with the conventional open repair. The disadvantage of EVAR is a phenomenon known as endoleak. This occurs when some blood flow returns to an otherwise de-functionalized aneurysm sac. There may be sufficient flow to cause pressurization and enlargement of the sac and, if left untreated, can result in rupture. Therefore patients who have their aneurysms repaired by EVAR need periodic examination. This is usually in the form of annual ultrasound examinations. Endoleaks usually occur in about 10% of patients, but very few of those require intervention. For the few that are associated with aneurysm sac enlargement, an angiogram followed by catheter based blocking of vessels producing the endoleak is usually all that is required. On rare occasion, when intervention is not successful, conversion to open repair may be necessary.

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