By James Wey, Christopher Chan, Elizabeth Quadros, Ziad Sergie, Jason Sousa, Lillian Hang

1

• By James Wey, Christopher Chan, Elizabeth
  Quadros, Ziad Sergie,Jason Sousa, Lillian Hang

2

• In the past 30 years, the incidence of AAA has
  tripled in the Western world and is the 13th
  leading cause of death in the US.
• There are approximately 200,000 patients
  diagnosed with AAA in the US each year, and
  approximately 500,000 patients diagnosed
  worldwide.

Estimated AAA Diagnosed each year. Adapted from
Lester et. al

• An estimated 60 of patients diagnosed with AAA
  are considered suitable for the new endovascular
  repair method.

3
Stent-Graft vs. Conventional Surgery

• The approximate cost for conventional
  open-chest surgery is approximately 31,000.
• There are approximately 110,000 conventional
  surgeries performed in 2001 worldwide, which
  amounts to an expenditure of about 3.41
  billion.
• Average ICU stay is about 55 hours.

• The stent-grafts costs 12,000, and the entire
  operation is approximately 27,000.
• There are approximately 85,000 stent- graft
  procedures performed in 2001 worldwide, which
  amounts to a cost of 2.3 billion.
• Average ICU stay is close to none.

4
Diagnosis and Risk Factors

• Diagnostic techniques
• Abdominal X-ray
• CT (Computed Tomography)
• MRI (Magnetic Resonance Imaging)
• Arteriogram
• Risk Factors
• Family History
• Increased age (over 60)
• Male gender
• Smoking
• High blood pressure
• High cholesterol
• Atherosclerosis
• Cardiovascular Disease
• Obesity

Sourcehttp//www.aorticaneurysm.com April 26,
2002
5
Treatment

• Do nothing except monitor the status of the
  aneurysm with routine ultrasounds. This option
  is preferred if the AAA is relatively small
  (4-6cm) and the patient is elderly or very
  high risk.
• Conventional surgery- Common choice of
  treatment for large aneurysms in otherwise
  young and healthy patients.
• Endoluminal surgery with stented graft- this
  usually represents the best choice for an
  elderly or high risk patient with an aneurysm
  that must be repaired.

Sourcehttp//www.aorticaneurysm.com April 26,
2002
Sourcehttp//www.aorticaneurysm.com April 26,
2002
6
Risks Associated with Treatment

• On the Operating Table
• failure to complete the procedure
• device-related or procedure-related complications
• and arterial complications
• Usually up to 30 Days Post-Operation
• graft-limb thrombosis or kinking
• peripheral embolization
• local hematoma or bleeding
• failure to advance the device into the correct
  position
• vascular laceration
• occlusion of the renal arteries
• device migration
• systemic complications related to organ failure
• paraplegia
• infection of insertion site
• endoleak (most common)

7
Risks Associated with Treatment (continued)

• Usually after 30 Days Post-Operation
• peripheral vascular occlusion
• device disruption or dislodgement
• aneurysm rupture
• Problems Discovered Upon Recovery of the Stent
• Stents without barbs or hooks detached readily
  from the native arteries
• Very little or no vascular tissue at all was
  found adhered to the fabrics
• constant endoleak and graft-migration
• Major Causes of Death
• anatomically incompatible device
• migrated stent causing the occlusion of renal
  arteries
• thrombosis
• post-operative renal failure(7 of stent-graft
  procedure)

8
Companies and the Devices

• FDA Approved
• Guidant - Ancure
• Medtronic - AneuRX
• In Clinical Trials
• Boston Scientific - Vanguard III
• Cook Group - Zenith
• Edwards Lifesciences - Lifepath
• Endologix - PowerLink
• W.L. Gore and Assoc. - Hemobahn Excluder
• Sulzer Vascutek - Anaconda
• TeraMed - Ariba
• World Medical - TalentManufacturing/Medtronic

9
Guidant

• Ancure
• Uses hooks to secure the graph in place
• 8,000 sold in 2001
• Made of Dacron and Elgiloy
• Recalled recently because the hooks
  damaged arterial walls

Sourcehttp//www.medicaldata.com April 26, 2002
10
Medtronic

• AneuRX
• Uses a pressure fit to secure the graft in place
• Made of Dacron and Nitinol
• Modular device
• 30,000 sold in 2001
• growth of sales is 80 per year
• More popular device than Guidants Ancure

Sourcehttp//www.medicaldata.com April 26, 2002
11
Future of the Endoluminal Stents

• Rapamycin coated stents
• Implant Sciences
• Gold-coated Nitinol Stent
• CardioTech
• ChronoFlex
• Use for Thoratic Aortic Aneurysms
• Non-Stented Grafts
• Surgical Assisted Therapies
• Use laproscopic techniques to secure the graft

SourceJ Thorac Cardiovasc Surg 2001 12247-52
Sourcehttp//www.ideasforsurgery.com/SAT_solutio
ns3.htmlApril 26, 2002