Endovascular Strategies for Abdominal Aortic Aneurysm Repair

Endovascular aneurysm repair (EVAR) has transformed the management of abdominal aortic aneurysm by offering a minimally invasive alternative to open surgery. Customisable stent-graft systems are introduced via the femoral arteries and deployed to exclude the aneurysmal sac from systemic pressure. Advances in device design—such as fenestrated and branched endografts—have extended treatment to complex anatomies involving renal and iliac vessels. Imaging guidance using computed tomography and intraoperative angiography ensures accurate graft placement, while improvements in sealing technology seek to reduce complications such as endoleak and migration. Patient selection emphasises aneurysm morphology, comorbidities and life expectancy, balancing procedural risk against long-term durability. Post-procedure surveillance remains critical, with duplex ultrasound or computed tomography used to monitor sac behaviour and detect late device failure. Ongoing innovation focuses on novel polymer-filled sealing systems, enhanced fixation mechanisms and personalised stent-graft sizing, aiming to improve outcomes and broaden applicability across diverse patient populations.

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Endovascular Strategies for Abdominal Aortic Aneurysm Repair publication trend

The graph below shows the total number of articles in endovascular strategies for abdominal aortic aneurysm repair across all publications each year (not limited to Nature Index journals).

Technical terms

Endovascular aneurysm repair (EVAR): A minimally invasive procedure in which a stent-graft is delivered through the femoral arteries to exclude an aneurysmal sac from blood flow.

Endoleak: Persistent blood flow outside the stent-graft lumen but within the aneurysm sac, classified by source (types I–IV) and impacting sac pressurisation.

Fenestrated endograft: A stent-graft featuring customised openings (fenestrations) to accommodate branch vessels such as renal or mesenteric arteries.

Limb graft occlusion: Thrombosis or blockage of an individual stent-graft limb, potentially leading to limb ischaemia and necessitating reintervention.

Aneurysm sac shrinkage: Reduction in aneurysm diameter after EVAR, indicative of successful exclusion and absence of significant endoleaks.

References

1. Editor's Choice -- European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Abdominal Aorto-Iliac Artery Aneurysms ☆. European Journal of Vascular and Endovascular Surgery (2024).
2. Prevalence and risk factors of type II endoleaks after endovascular aneurysm repair: A meta-analysis. PLOS ONE (2017).
3. Limb Graft Occlusion Following Endovascular Aneurysm Repair for Infrarenal Abdominal Aortic Aneurysm with the Zenith Alpha, Excluder, and Endurant Devices: a Multicentre Cohort Study. European Journal of Vascular and Endovascular Surgery (2021).