Due to the better short term outcomes EVAR is favored over open-surgery, and this is still the drive behind the ongoing trend towards more EVAR and less open surgical repair. Currently, the short term benefits are outweighed over a 5-year period by the better durability of the surgical intervention.
This is mainly due to the higher rate of complications for EVAR. As a consequence, EVAR patients need to follow-up over the long term to early diagnose these complications. This higher complication rate also results in a higher re-intervention rate. These remaining clinical needs have sparked innovation and successful market introduction of new EVAR endografts and ancillary devices over the last decade, and will be doing so as long as the remaining clinical needs have not been solved.
Remaining Clinical needs
- Aneurysm outside device IFU
- Unsuccesful EVAR stent placement
- Remaining blood inflow/ outflow
- Misalignment of the 2 stent parts
- (Late) stent material failure
- Hostile neck anatomy
- Angulated neck > 60°
- Short neck < 10 mm
- Large Diameter > 32 mm
- Collapse of the EVAR stent
- Misalignment of vessel and stent