Aortic aneurysm: abdominal aortic aneurysm—therapeutic options

For uncomplicated abdominal aortic aneurysms (AAAs), small ones (<55 mm in diameter) are generally subject to surveillance, while larger ones (≥55 mm in diameter) should be considered for aneurysm repair. There is no benefit of a timely repair for small AAAs, regardless of repair method and patient age. Aortic aneurysm, however, is a surrogate for cardiovascular morbidity, thus risk factor management and secondary preventive drug treatment is essential in all AAA patients. Several studies have attempted to address the optimal pace for ultrasound surveillance of small aneurysms and based on a recent large meta-analysis, intervals of 3 years, 1 year, and 6 months were proposed for AAAs measuring 30–39, 40–49, and 50–54 mm, respectively. In patients with a large aneurysm, open or endovascular aortic repair (EVAR) is the primary treatment option. The goals for both repair techniques are identical, although the treatment strategy is completely different. During EVAR, the aneurysm is left intact, and the blood flow is excluded from the aneurysm by catheter-based deployment of a stent graft; thus, successful EVAR procedures are bound to specific anatomical conditions. In cases that are anatomically and physiologically eligible for both conventional EVAR and open repair, EVAR was associated with a substantial early survival advantage; this benefit, however, was lost over time. The rate of late rupture was significantly higher after endovascular repair than after open repair. In patients with a ruptured AAA, an individual patient data meta-analysis from three randomized controlled trials reported similar survival to 90 days following an endovascular or open repair strategy.