Endovascular stent graft repair of abdominal and thoracic aortic aneurysms: a ten-year experience with 817 patients.

Endovascular Stent Grafts (ESG) are evolutionary medical devices that blend the vessel wall fixation properties of metallic intravascular stents with the arterial conduit properties of prosthetic vascular grafts. One of the first proposals for a minimally invasive intraluminal bypass was included with the initial clinical developments of catheter-based vascular intervention in the early 1960s.1–2 The landmark work by Dotter et al using arterial angioplasty and vascular stents suggested the application of these newly developed devices to the treatment of traumatic arterial injuries and aneurysms.3 Preclinical developments followed in several centers around the world focused predominantly on 3 areas: determining the best mechanism to provide graft fixation to the vessel wall; identifying an ideal conduit to bridge the vascular defect; and developing techniques to reliably deliver an ESG to a target vessel.4–8 The first published clinical application of ESG technology was by Volodos et al in the Ukraine.9–10 Shortly thereafter, Parodi et al repaired the first abdominal aortic aneurysm.11 The logical extension of the ESG concept to long segment arterial occlusive disease, aneurysms of the thoracic aorta and peripheral arteries and vascular trauma soon followed.12–19 The first endovascular aortic aneurysm repair in the Unites States was performed on November 23, 1992.20 This report summarizes a single experience that begins with that first patient treated in the United States and continues with the ESG treatment of 817 patients over a 10-year period.