Evolution of technologies in endovascular grafting.

The safety, efficacy and utility of inserting a vascular prosthesis through the femoral artery and attaching it to a native artery with stents to treat abdominal aortic aneurysms are under various stages of testing around the world. The potential of these endovascular techniques to reduce the morbidity and cost of care is enormous. Many advances in imaging, catheter techniques, delivery systems and the knowledge about aneurysm morphology are responsible for the progress to date. The requirements of an endoprosthesis include a small and flexible delivery system that allows retrograde insertion through the iliofemoral arterial system, secure attachments to normal arterial wall, and a fabric which meets Food and Drugs Administration criteria for strength and durability. Application of this technique to large numbers of patients with aneurysms will probably require the development of a bifurcated prosthesis. The long-term behavior of the aneurysm wall after endoprosthesis insertion will not be known until clinical trials are completed. The development of these techniques will undoubtedly fuel the 'turf battle' between vascular surgeons and interventionalists. Although each group will lay claim to the technology, a cooperative effort to maximize patient benefit seems to be the most appropriate way to insure that the interests of the patients are best served.