Endovascular stenting for descending aneurysms: Wave of the future or the emperor’s new clothes?

Indolent nature of thoracic aortic aneurysm. Survival before operative repair is shown for different size classes. Note that years generally pass before the mortality risk expresses itself, even for large aneurysms. Source: Coady MA, Rizzo JA, Hammond GL, et al. What is the appropriate size criterion for resection of thoracic aortic aneurysms? J Thorac Cardiovasc Surg. 1997;113:476-91. Reprinted with permission from Elsevier Inc.

Kaplan–Meier graph representing cumulative freedom from any endoleak in patients operated on for abdominal aortic aneurysm with endovascular aneurysm repair. Source: Lange C, Leurs LJ, Buth J, et al. Endovascular repair of abdominal aortic aneurysm in octogenarians: an analysis based on EUROSTAR data. J Vasc Surg. 2005;42:624-30. Reprinted with permission from Elsevier Inc.

Cumulative freedom from aneurysm-related death. Note low attrition of survival in first 3 years of follow-up and rapid attrition in fourth year. Gp, Group. Groups represent increasing initial aneurysm size: group A, 4.0 to 5.4 cm; group B, 5.5 to 6.4 cm; group C, 6.5 cm or larger. Source: Peppelenbosch N, Buth J, Harris PL, et al. Diameter of abdominal aortic aneurysm and outcome of endovascular aneurysm repair: does size matter? A report from EUROSTAR. J Vasc Surg. 2004;39:288-97. Reprinted with permission from Elsevier Inc.