Aortic Aneurysm Repair

About Aortic Aneurysm Repair

Abdominal aortic aneurysm repair is performed to prevent rupture of an abnormally widened section of the abdominal aorta, a catastrophic event that is frequently fatal. Aneurysms are more common in older men and in people who smoke or have a family history, and many are found incidentally or through population screening programs. Repair is generally considered when an aneurysm reaches a size at which the risk of rupture outweighs the risks of surgery, when it grows rapidly or when it causes symptoms. Open repair is performed through an abdominal or retroperitoneal incision: the aorta is clamped above and below the aneurysm, the sac is opened and a synthetic fabric graft is sewn in place. Endovascular aneurysm repair, EVAR, first performed by Juan Parodi in Argentina in 1990, places a fabric covered stent graft inside the aneurysm through catheters introduced via the femoral arteries under X ray guidance, excluding the aneurysm from blood flow. Large randomized trials, including the British EVAR 1 trial and the Dutch DREAM trial, found that EVAR has lower early mortality and a shorter recovery, while long term survival is broadly similar to open repair. EVAR requires long term imaging surveillance because of endoleaks, persistent blood flow into the aneurysm sac, some of which need further treatment. Fenestrated and branched stent grafts allow treatment of aneurysms involving the arteries to the kidneys and gut. A ruptured aneurysm is a surgical emergency with high mortality despite treatment.