Vascular stents and development of endoluminal therapy of aortic aneurysm

Intravascular stents have played an important role in improving early and long-term patency in the treatment of arterial occlusive disease, particularly in the iliac arteries after failed balloon angioplasty. The development of covered stents opened a new dimension for non-operative therapy of aneurysmal disease. Transluminally placed stent-grafts represent a blending of technologies with use of intravascular stents and prosthetic vascular grafts. Stent-graft combinations were first envisioned by Dotter in 1969 as devices that would ultimately be useful to treat aneurysms, pseudoaneurysms and arterio-venous fistulas. Animal studies of endovascular stented grafts demonstrated the potential feasibility of these devices to treat arterial lesions. Parodi et al. first implanted stent-grafts in patients with abdominal aortic aneurysms and demonstrated its clinical feasibility. Newly developed stent-grafts allowed to treat successfully a limited number of patients with AAA. Although much has been reported about the healing properties of prosthetic grafts in extraluminal locations, there are only little data concerning the arterial response to a prosthetic graft placed within the lumen or anchored into the wall of a human vessel. Therefore, long-term evaluation of these new devices will be crucial.