The evolution of stent grafts for endovascular repair of abdominal aortic aneurysms: how design changes affect clinical outcomes

Introduction: Abdominal Aortic Aneurysm (AAA) is a potentially life-threatening condition caused by the ballooning of the patient's aortic wall. One treatment for this condition, Endovascular Aneurysm Repair (EVAR), has demonstrated a greater degree of safety in the short term and has the potential to be more cost-effective than its open surgical counterpart.Areas covered: EVAR comes with the added risks of late-term failure, however, as the endografts are subject to displacement, loss of seal against the aortic wall, or failure to serve as a means of bypassing the aneurysm. Device manufacturers have made constant iterations to the endoprostheses available on the market to reduce these complications, expand the pool of suitable patients, and reduce cost of endovascular repair while ensuring patient safety and strong clinical outcomes.Expert opinion: Short and midterm clinical outcomes have improved markedly over 20 years and the number of patients who qualify for EVAR has increased dramatically. Late-term failures and the need for life-long monitoring for complications remain the Achille's heel for this treatment paradigm. Differences in short- and long-term outcomes, as well as overall costs related to lifelong monitoring and late-term complications and reinterventions, still require continuous comparison to previous devices and the historically proven open surgical repair.