Patient selection for endovascular repair of abdominal aortic aneurysms: changing the threshold for intervention.

The success of endovascular graft repair depends greatly on appropriate patient selection. These selection criteria are completely different from those traditionally used for open repair. Although each endovascular graft has its own unique criteria, several anatomic constraints are common for each graft, including presence of a proximal and distal landing zone, absence of indispensable branches arising from the aneurysm, and an access artery large enough to accommodate the delivery system. Although theoretically attractive, due to the uncertainty regarding long-term durability and a finite incidence of both conversion and perioperative mortality, endovascular repair of the small aortic aneurysm is not justified at this time.