Endovascular Aortic Repair

Abstract

Endovascular aortic repair is a widespread alternative for a multitude of aortic pathologies, yet tools and understanding are still rapidly advancing. The aim of this thesis is to contribute to current knowledge on risk factors for endovascular aortic repair – exploring the binomial patient-device – to clarify endovascular-specific complications and contribute to a risk-based strategy of postoperative surveillance. In Part One, the authors address controversial issues related to endovascular repair of the thoracic aorta. In Part Two, the risk factors for endovascular aneurysm repair (EVAR) of the abdominal aorta are explored. In Part Three, the authors have analyzed the applicability of endovascular treatment for aortic aneurysm rupture. In Part Four, mid- to long-term device-specific outcomes are reported. In Part Five, possible complications of EVAR are scrutinized, aiming to clarify their significance and potential treatment strategies. In Part Six, the authors contribute to optimize postoperative surveillance. Treatment of aortic pathology by means of endovascular implantation of covered stents is generally associated with improved early outcome. The caveat is a higher risk of late complications, which lead to a small but significant persistent risk of disease-related mortality or morbidity. Understanding the significance of endovascular-specific complications avoids unnecessary reinterventions and adds reassurance to patients and physicians. Fine-tuning patient and device selection is a necessary step to reduce late morbidity and improve durability, consequently reducing the intensity of postoperative surveillance.