Innovation in vascular surgery: How aortic endografts have revolutionized the treatment of aortic aneurysms

Aneurysm of the abdominal aorta is a serious illness. Without intervention, the aneurysm grows and eventually ruptures, with a fatal outcome in the majority of cases. Open aortic surgery has been the treatment of choice for many years, but over the last fifteen years aortic endografts has gained ground dramatically and has been validated by several randomized controlled studies. Less invasive and associated with a lower postoperative morbidity, the endovascular treatment has made enormous progress in the recent years and has disrupted our surgical practice. At the risk of disappearing, any active vascular surgeon in 2000 practicing aortic surgery had to relearn his specialty. As with all innovations, there have been excesses because aortic endografts meet strict anatomical criteria that must be respected, which has not always been the case. For the most sophisticated techniques involving the thoracoabdominal aorta and the aortic arch, specific learning and the provision of a hybrid room are essential. In addition, these centers must have the necessary recruitment to maintain this expertise, hence the notion of centralization has complemented the sophistication of these techniques. This article presents the different endovascular innovations concerning the treatment of aortic aneurysms by describing the necessary steps for the endovascular training of the surgeons and also the limits of these innovative techniques. (C) 2019 l'Academie nationale de medecine. Published by Elsevier Masson SAS. All rights reserved.