Management of Abdominal Aortic Aneurysms

Abdominal Aortic Aneurysms Repair of abdominal aortic aneurysm is recommended in men with an aneurysm of 5.5 cm or more and in women with an aneurysm of 5.0 cm or more. In randomized trials, endovascular aortic aneurysm repair was associated with a lower risk of perioperative complications and death than open surgical repair, but mortality was similar after approximately 2 years. After endovascular repair, long-term imaging surveillance is recommended. Key Clinical Points Management of Abdominal Aortic Aneurysms Risk factors for abdominal aortic aneurysm include advanced age, male sex, family history, previous or current use of tobacco, hypercholesterolemia, and hypertension. The risk is lower among patients with diabetes mellitus. Repair is recommended for male patients in whom the maximum diameter of the aneurysm is 5.5 cm or more and in female patients in whom the maximum diameter is 5.0 cm or more. The results of randomized, controlled trials indicate that endovascular aortic aneurysm repair (EVAR) is associated with a lower risk of perioperative complications and death than open surgical repair. The early advantage of EVAR over open surgery is maintained for an average of 2 to 3 years from the time the procedure was performed. There is no long-term advantage regarding survival. Although EVAR is associated with a higher risk of reintervention, most such interventions involve minor endovascular procedures. Over a patient's lifetime, open repair is associated with a higher risk of reintervention related to the laparotomy. Long-term imaging surveillance with duplex ultrasonography or computed tomographic angiography is recommended in patients who undergo EVAR.

Automated summary

Repair of abdominal aortic aneurysm is recommended in men with an aneurysm of 5.5 cm or more and in women with an aneurysm of 5.0 cm or more. Endovascular aortic aneurysm repair has lower risk of perioperative complications and death compared to open surgical repair, but there is no long-term survival advantage. Long-term imaging surveillance is recommended after endovascular repair.