Dear Colleagues,

 

Abdominal Aortic Aneurysm (AAA) is typically a disease of older males with increasing prevalence after the 6th decade of life and an incidence of 6.5 per thousand person years. 10% of the population older than 65years presents an AAA.

The endovascular aneurysm repair (EVAR) is considered nowadays the mainstay treatment of AAA compared to open repair due to its minimal invasive nature and its lower perioperative mortality and morbidity. The fundamental philosophy of the stent-graft technology is focused on the exertion of a radial force continuously applied by a Nitinol skeleton, over-sized with regard to the diameter of the healthy infrarenal aortic segment. This sealing technology, often coupled with suprarenal fixation mechanisms, carries certain limitations with respect to minimum anatomical requirements of angulation, diameter and length of the infrarenal and iliac sealing zones.
 
The sealing and fixation mechanisms, the accuracy of deployment and the profile of the delivery devices have evolved rapidly over the last decade with newer endografts recruited to widen the eligibility for EVAR at no cost to safety and efficacy. Moreover, sophisticated and technically demanding endovascular techniques (branched-, fenestrated- or chimney EVAR) were developed to manage pararenal, juxtarenal and thoracoabdominal AAA, while modified designs were introduced to address simultaneously the presence of iliac aneurysms accompanying AAA. However, despite the initial enthusiasm, certain queries remain still unanswered, such as the mid- and long-term clinical success of the newer endografts, the competitive efficacy of fenestrated- and chimney EVAR in the treatment of complex AAA and the management of technical failures of the new endograft designs. 

Aim of this issue is to present the current status of endovascular treatment of AAA, describe the technical improvements and modifications of previous and newer endograft designs, compare the critical issues related to the advanced treatment modes of complex AAA and address the challenges to treatment of failures of the new endograft designs.

 

Prof. Dr. Efstratios Georgakarakos

Guest Editor