May 7, 2007

No Fix for Stent-grafts Are stents and stent-grafts at an evolutionary dead-end? Do extended suprarenal stents with more flexibility lead to more acute fixation? Will a shorter sealing zone, a shorter stent length, and electropolished stents fulfill the need of a durable and permanent abdominal aortic aneurysm (AAA) repair? In the past, the favorable morbidity and mortality outcomes of stent-graft procedures have led to increasing demand from both the public and medical profession. The good news: it has been suggested that an endoluminal repair

results in less postoperative pain and gastrointestinal dysfunction. The bad news: with the available stent-graft procedure (EVAR), reintervention is required in a substantial number of patients. The most common reasons for secondary intervention have been aneurysm rupture, lack of seal and enlargement with or without endoleaks, graft limb occlusion, and/or stentgraft migration. The potential mechanisms for the migration of stent-grafts include poor proximal graft fixation and infrarenal aortic neck dilatation. Many stent-graft marketers and design engineers attempt to reduce the longitudinal columnar strength of the stent-graft in order to allow for more resistance to the migration of the graft. The sales and marketing representatives try to convince the physician community to use more modular components for stenting the iliac limbs all the way to the hypogastric bifurcation. According to the stent-graft companies and their physician consultants, this may offer longer fixation zones with larger and longer stented iliac limbs. Other designs come with a proximal uncovered stent, which is deployed so as to cover one or both renal artery orifices. Nevertheless, the forces acting within the pressurized aorta and upon a stent-graft overcome the limited fixation of radial attachment. The curvature of the graft limbs creates an additional sideways force that works to displace the distal limbs of the stent-graft from the iliac arteries. The many questions about device design, fixation, durability, and deployment methods are cause to search for new techniques. Patients are assuming an increasingly dominant role in decisions about their care and many are less than thrilled about the bad news for stents. The need for less-invasive procedures is the driving force for new designs of endoluminal grafts with methods for secure and permanent fixation. - Further the future ain t what it used to be
No Rights Reserved. No One Owns It. Everyone Can Use It. Anyone Can Improve It.