Future Technologies to Address the Failed Endoprosthesis

Endovascular aneurysm repair (EVAR) has transformed therapy for aortic aneurysms and introduced an era of widespread use for endovascular procedures in a variety of vascular beds. While dramatic improvements in acute outcomes drove the early enthusiasm for EVAR, a realization that the integrity of the endoprostheses used for EVAR was significantly inferior to results obtained with open surgical reconstruction dampened enthusiasm for their use in low-risk patients and mandated long-term follow-up for EVAR patients. The future of EVAR as a primary approach to aortic aneurysm repair rests on development of technologies and techniques that can reproduce the foundations and, therefore, the results of open surgical reconstruction. Many of these technologies will be used initially to address the failing endoprostheses, but will have a larger role in their application as a primary component of EVAR.