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Chapter-12 Endovascular Repair of Abdominal Aortic Aneurysms

BOOK TITLE: Recent Advances in Surgery 33

Author
1. Nammuni Isuru S
2. Boyle Jonathan R
ISBN
9789380704227
DOI
10.5005/jp/books/11221_12
Edition
1/e
Publishing Year
2010
Pages
17
Author Affiliations
1. Vascular Surgery Unit, Addenbrookes Hospital, Cambridge, UK
2. Cambridge Vascular Unit, Cambridge University Hospitals, Cambridge, UK
Chapter keywords

Abstract

Over the last 40 years, the prevalence of abdominal aortic aneurysms (AAA) has steadily increased. The vast majority of AAAs are asymptomatic until they rupture. Despite major medical advances during this period, the overall mortality after rupture remains as high as 80%. The aim is, therefore, to detect and repair these aneurysms electively to evade this high mortality. It is clear that endovascular aneurysm repair is a rapidly advancing area of vascular surgery. As endografts continue to be improved and our long-term experience grows, EVAR is sure to have a positive impact on mortality rates for aneurysmal disease. Population screening with ultrasound for men > 65 is cost-effective and improves survival. EVAR has the same size threshold for intervention as open repair (5.5 cm for men and 5.0 cm for women). Key anatomical considerations for EVAR are infrarenal neck length, angulation, and iliac aneurysm, occlusive disease or tortuosity. Every effort should be made to preserve the internal iliac arteries. Fabric failure and stent fractures are uncommon with modern devices. All type I and type III endoleaks require intervention. Most type II endoleaks can be managed expectantly. If no concerning endoleaks and increase in sac size are found in the first year, ongoing surveillance with ultrasound and plain radiographs is adequate. EVAR has significantly lower procedural mortality than open aneurysm repair. EVAR has equivalent mortality to open repair in the medium term. Long-term results are unknown with current devices and endovascular practices. EVAR for ruptured aneurysms appears to improve outcomes. No scoring systems have been validated for patients undergoing emergency EVAR. Hypotensive hemostasis is an important part of preoperative management. Often a compromise must be made between anatomical requirements and the graft sizes available on hand. Local anesthesia should be used whenever possible.

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