Endovascular grafting for abdominal aortic aneurysms.

Despite the initial success of endovascular grafts in a very difficult patient population, many problems remain. These procedures are often time-consuming and quite complicated, requiring the close cooperation of an experienced team of vascular surgeons and interventional radiologists. Access may be difficult through occluded, stenotic, and tortuous vessels. Inadequate graft deployment may result in arterial rupture or graft migration, which could potentially lead to acute occlusion of the renal or iliac arteries. Occlusion of the inferior mesenteric artery may result in ischemic colitis. Also, endovascular grafts may fail to exclude an aneurysm from systemic arterial blood pressure, not protecting the patient against impending rupture, and embolization and thrombosis are ever-present dangers. Concerns have been raised regarding radiation exposure and intravenous contrast loads used during these procedures. Clearly, more experience must be gained and technologic advancements made before the use of these devices becomes commonplace, something that may not be too far off in the future.