Endovascular repair:

This is a minimally invasive (keyhole surgery) technique. The graft is placed inside the aneurysm through 2 small cuts in the groin. Therefore the need for the major abdominal surgery is avoided.

However there are still some concerns about this technique at present - and research is being done to address these.

Firstly the graft is held in place by a "stent" - this is a wire tube that holds it's place by pushing outwards against the aortic wall. As the aortic wall is already weak and is giving way (hence the formation of the aneurysm in the first place) extra pressure on it by the stent is not an ideal solution. Moreover, as the aorta continues to dilate, the stent is likely to reach its maximum diameter - then unable to keep up with the failing wall it falls down taking the graft with it.

This problem was raised in an article in the Lancet some years ago and really still needs to be answered.

At the moment we know there is a high death rate if we have to remove an endovascular aortic graft. We also know that a few fail either immediately by allowing blood to leak outside of the stent and graft, or in the first 1-3 years.

As such I do not believe that this procedure has been fully worked out and as such feel that it should probably still be subject to research studies rather than be widely available. Having said that, there are certainly an increasing number of people who seem to be suitable for this as more people survive to older age with serious medical problems that make open surgery undesirable.

My belief is that for this, as with any new procedure, it should be done by enthusiastic surgeons in centres involved in research so that any bad results can feed back to make improvements in techniques and materials. At the moment I do not feel that the technique is far enough advanced to be made widely available to all patients and as this is not my major area of research, I do not offer endovascular aneurysm repair.