New trends in management Of Abdominal Aortic Aneurysm

Abstract

Summary

A bdominal aortic aneurysm is a common and potentially life-threatening condition. Without repair, ruptured AAA is nearly uniformly fatal, so the goal of treatment of AAA is to prevent rupture.

The treatment options depend on several major factors. First of all the size of the aneurysm, secondly, whether it is asymptomatic or symptomatic and finally the site of the aneurysm, so the treatment options available are conservative, surgical or endovascular.

Conservative management consists of periodic clinical evaluation and surveillance of aneurysm diameter to identify AAA that exceeds the threshold for repair or is rapidly expanding. The goal of conservative management is to reduce morbidity and mortality associated with AAA repair.

Intervention for AAA repair, whether by open surgical repair or endovascular repair is recommended in symptomatic patients regardless the size of the aneurysm and in asymptomatic patients if the size of the aneurysm diameter < 5.5 cm. or rapidly expanding ( < 1cm. per year).

When it has been determined that a patient should undergo elective AAA repair, some points should be taken into consideration such as, anatomical factors, patient’s age, gender, preference, risk of AAA rupture and risk for perioperative morbidity and mortality, so that an appropriate decision can be made regarding the type of repair.

Endovascular repair is associated with lower perioperative morbidity and mortality compared with open AAA repair, especially with continuous evolution in devices and techniques used in the process of endovascular repair, however it does not completely eliminate the risk of AAA rupture, whereas open repair is associated with highermorbidity and mortality than EVAR, but provides a more definitive repair.