1. By James Wey, Christopher Chan, Elizabeth Quadros, Ziad Sergie, Jason Sousa, Lillian Hang

2. In the past 30 years, the incidence of AAA has tripled in the Western world and is the 13th leading cause of death in the US. There are approximately 200,000 patients diagnosed with AAA in the US each year, and approximately 500,000 patients diagnosed worldwide. Estimated AAA Diagnosed each year. Adapted from Lester et. al An estimated 60% of patients diagnosed with AAA are considered suitable for the new endovascular repair method.

3. The stent-grafts costs $12,000, and the entire operation is approximately $27,000. There are approximately 85,000 stent- graft procedures performed in 2001 worldwide, which amounts to a cost of $2.3 billion. Average ICU stay is close to none. Stent-Graft vs. Conventional Surgery The approximate cost for conventional open-chest surgery is approximately $31,000. There are approximately 110,000 conventional surgeries performed in 2001 worldwide, which amounts to an expenditure of about $3.41 billion. Average ICU stay is about 55 hours.

4. Diagnostic techniques: Abdominal X-ray CT (Computed Tomography) MRI (Magnetic Resonance Imaging) Arteriogram Risk Factors Family History Increased age (over 60) Male gender Smoking High blood pressure High cholesterol Atherosclerosis Cardiovascular Disease Obesity Diagnosis and Risk Factors Source: http://www.aorticaneurysm.com April 26, 2002

5. Do nothing except monitor the status of the aneurysm with routine ultrasounds. This option is preferred if the AAA is relatively small (4-6cm) and the patient is elderly or very high risk. Conventional surgery- Common choice of treatment for large aneurysms in otherwise young and healthy patients. Endoluminal surgery with stented graft- this usually represents the best choice for an elderly or high risk patient with an aneurysm that must be repaired. Treatment Source: http://www.aorticaneurysm.com April 26, 2002

6. On the Operating Table failure to complete the procedure device-related or procedure-related complications and arterial complications Usually up to 30 Days Post-Operation graft-limb thrombosis or kinking peripheral embolization local hematoma or bleeding failure to advance the device into the correct position vascular laceration occlusion of the renal arteries device migration systemic complications related to organ failure paraplegia infection of insertion site endoleak (most common) Risks Associated with Treatment

7. Usually after 30 Days Post-Operation peripheral vascular occlusion device disruption or dislodgement aneurysm rupture Problems Discovered Upon Recovery of the Stent Stents without barbs or hooks detached readily from the native arteries Very little or no vascular tissue at all was found adhered to the fabrics constant endoleak and graft-migration Major Causes of Death anatomically incompatible device migrated stent causing the occlusion of renal arteries thrombosis post-operative renal failure(7% of stent-graft procedure) Risks Associated with Treatment (continued)

8. FDA Approved Guidant - Ancure Medtronic - AneuRX In Clinical Trials Boston Scientific- Vanguard III Cook Group- Zenith Edwards Lifesciences- Lifepath Endologix- PowerLink W.L. Gore and Assoc.- Hemobahn; Excluder Sulzer Vascutek- Anaconda TeraMed- Ariba World Medical - Talent Manufacturing/Medtronic Companies and the Devices

9. Ancure Uses hooks to secure the graph in place 8,000 sold in 2001 Made of Dacron and Elgiloy Recalled recently because the hooks damaged arterial walls Guidant Source: http://www.medicaldata.com April 26, 2002

10. AneuRX Uses a pressure fit to secure the graft in place Made of Dacron and Nitinol Modular device 30,000 sold in 2001 growth of sales is 80% per year More popular device than Guidant’s Ancure Medtronic Source: http://www.medicaldata.com April 26, 2002

11. Rapamycin coated stents Implant Sciences Gold-coated Nitinol Stent CardioTech ChronoFlex Use for Thoratic Aortic Aneurysms Non-Stented Grafts Surgical Assisted Therapies Use laproscopic techniques to secure the graft Future of the Endoluminal Stents Source: http://www.ideasforsurgery.com/SAT_solutions3.html April 26, 2002 Source: J Thorac Cardiovasc Surg 2001; 122:47-52