**8. Future developments**

### **8.1. Totally percutaneous procedures**

Because local groin wound complications as a result of the exposure of the two common femoral arteries are not negligible [84], surgeons and engineers tried to develop alternative access techniques. One of them is the fully percutaneous procedure. The main device available is Perclose ProstarXL(Abbott). For technical success patient and device selection should be done. Severe femoral artery calcification, scarred groins, femoral artery aneurysms are contraindications for the use of these devices. The overall related complications were 4.4%. Among them infection and artery trombose are the most redoubtable. The hospital stay is shorter in patients undergoing P-EVAR (2.7 days vs. 3.5 days) compared with EVAR. In conclusion, P-EVAR appears safe and effective in selected patients.

#### **8.2. MRI devices**

A new research field in our days is based on the hypotheses that the endografts can be visualized and navigated in vivo solely under Rt-MRI(real time magnetic resonance imaging). MRI can provide immediate assessment of endograft apposition and aneurysm exclusion. MRI offers also better soft tissue visualization, detecting type I endoleaks by depiction of complex 3D anatomy.

The technique is now applicable on murine models of AAA [85]. They have used a passive commercial endograft, image based on metal MRI artefacts, and active homemade endografts incorporating MRI receiver coils (antennae). Active devices proved to be most useful. The MRI images proved graft apposition and aneurysm exclusion. MRI imaging also permits immediate post-procedural anatomical and functional evaluation of the successful procedure.

In conclusion, MRI may be equivalent or superior to computed tomography for procedure planning and surveillance of the endografts. Future development of active devices is required, in order to have a commercial graft that can be used in clinical testing and practice.
