ABSTRACT
Although there remains an element of uncertainty and at times overt skepticism regarding the current results of aortic endografting, for the elderly, physiologically disadvantaged patient with a large abdominal aortic aneurysm, the technology has created previously nonexistent options for treatment. The importance of patient selection predicated on meticulous and sophisticated anatomical assessment cannot be overemphasized. The aortic endografting devices have also created a host of new challenges and in some cases major obstacles for practicing vascular surgeons. Even for those individuals experienced in performing endovascular interventions, aortic endografting mandates a learning curve that is often protracted and tedious given the first-generation nature of the two FDA-approved devices. Although the manufacturers of the Ancure (Guidant/Endovascular Technologies, Menlo Park, CA) and AneuRx (Medtronic, Santa Rosa, CA) stent grafts have committed themselves to physician training, all too often appropriate patient selection, meticulous endograft design, and successful deployment of these 200devices does not result in prompt exclusion of the aneurysm sac. The focus of this chapter is on the diagnosis and treatment of intraoperative endoleaks and, in particular, the approaches and techniques that we have evolved during our first 300 cases performed at the University of Pennsylvania.
