Since the first catheter-based abdominal aortic aneurysm (AAA) repair procedure was performed in 1990, propelling cardiovascular disease treatment into the minimally invasive age, evolving endograft and delivery system designs have had a tremendous impact on the treatment of life-threatening AAAs. Twenty-one years later, the shift to endovascular AAA repair (EVAR) has led to markedly shorter hospitalization and recovery times, along with reduced perioperative morbidity and mortality in comparison with open surgical repair, although long-term EVAR outcomes still suffer from graft durability issues and the need for reintervention. Today, advanced EVAR designs from both large vascular players and innovative start-ups are striving to meet the needs of patients with more complex anatomies by offering products with lower profiles (including percutaneous), enhanced flexibility, conformability, deployment and fixation. ( See Exhibit 1.) Coupled with an increased emphasis on AAA screening for the aging population and thus a growing pool of diagnosed patients, EVAR is a rare shining star in an otherwise maturing and pricing-pressured medical device industry. The 2010 US EVAR market is valued at over $550 million (approaching $1 billion worldwide), and is growing at about 8 to 9% per year.
An AAA is a weakened section of the large vessel that supplies blood to the lower half of the body. Blood pressure forces it to balloon out until it eventually...