By James Wey, Christopher Chan, Elizabeth Quadros, Ziad Sergie,

Jason Sousa, Lillian Hang

• In the past 30 years, the incidence of AAA has tripled in the Westernworld and is the 13th leading cause of death in the US.

•There are approximately 200,000 patients diagnosed with AAA in the USeach 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.

•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.

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.

•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

Diagnosis and Risk Factors

Source:http://www.aorticaneurysm.com

April 26, 2002

•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.

Treatment

Source:http://www.aorticaneurysm.com

April 26, 2002

Source:http://www.aorticaneurysm.com

April 26, 2002

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)

Risks Associated with Treatment

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)

Risks Associated with Treatment (continued)

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

Companies and the Devices

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

Guidant

Source:http://www.medicaldata.com

April 26, 2002

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 Guidant’s

Ancure

Medtronic

Source:http://www.medicaldata.com

April 26, 2002

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 tosecure the graft

Future of the Endoluminal Stents

Source:http://www.ideasforsurgery.com/

SAT_solutions3.htmlApril 26, 2002

Source:J Thorac Cardiovasc Surg 2001; 122:47-52