Endovascular Repair of Abdominal and Thoracic Aortic Aneurysms

Posted by e-Medical PPT Tuesday, June 5, 2012
A ruptured AAA has a mortality rate approaching 90%.When an AAA is repair electively, the mortality drops to less than 5%.AA affects 4% 7% of adult over the age of 65 years, with a far greater prevalence in male than in female, this problem will encounter more frequently as population ages.

Indications for AAA treatment
Patients with symptomatic aneurysms should be offer repair, after careful consideration of comorbidities, even if the aneurysm is not of usual elective operation size.Patients with the aneurysm increases in size by 1 cm per year.
Most asymptomatic AAA’s are discovered by accident often on imaging examination for other complains.
For the patients with asymptomatic AAA’s there is guidelines to help plan further surveillance or operative repair.
The size of the AAA is one factor, and the operative approach is another.
In general, the clinical recommendation remains to offer treatment for AAA between 5 and 5.5 cm, depending on the results of clinical trials.

Clinical and Anatomical Selection Factors
Patient selection has emerged as the most important factor related to successful EVAR.
3D reconstruction CT scan or angiography with a calibrated catheter necessary for assessment for EVAR eligibility.
Proximal neck: diameter, length, angel, presence or absence of thrombosis
Distal lending zone: diameter and length
Iliac arteries: presence of aneurysm or occlusive disease
Access arteries: diameter, presense of occlusive disease
Up to 37% of all patients may NOT be suitable candidate for EVAR of their infrarenal AAA.

Contraindications for EVAR
Short of proximal neck
Thrombus present in proximal landing zone
Conical proximal neck
Greater than 120ยบ angulations of the proximal neck
Critical inferior mesenteric artery
Significant iliac occlusion
Torture of iliac vessels

Indication for EVAR AAA repair
Open repair is advocated for younger, lower-risk patients.
Open surgical repair of AAA has proven long-term durability.
EVAR is preferred for older, high risk patients.
EVAR has shown a reduction in 30-day mortality relative to that achieved with open repair ( 1.2% versus 4.6% )
EVAR follow up is now 15 years.
Further study is required to determine whether there is a long-term survival advantage.
Risk stratification determines survival in general and shows that both open surgery and EVAR decrease the risk of death from AAA rupture..

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