Abdominal Aortic Aneurysms.
The mortality rate after the rupture of an abdominal aortic aneurysm is 80% to 90%; therefore, the main goal of treatment is to prevent rupture. Patients with abdominal aortic aneurysms smaller than 5 cm in diameter should be managed conservatively under close surveillance with either computed tomography or sonography every 3 to 12 months. Patients should be informed that most aneurysms continue to enlarge at an average rate of 2 to 4 mm per year and that there is a 1% to 5% annual risk for sudden rupture. Treatment of the aneurysm is generally recommended if it is larger than 5 cm in diameter, and the only effective treatment is replacement of the aneurysm with a prosthetic graft. This can be performed through a laparotomy or a groin incision using an endovascular graft. Open surgical repair carries a mortality rate of 2% to 8% and requires a hospital stay of 7 to 10 days. Patients receiving endovascular grafts can be discharged within 1 to 3 days. Long-term durability has yet to be proven, however.
Ohki
T
Division of Vascular Surgery, Department of Surgery, Montefiore Medical Center and Albert Einstein College of Medicine, New York, NY 10467, USA.
Veith
FJ