Should the size threshold for elective abdominal aortic aneurysm repair be lowered in the endovascular era? Yes.
According to current international guidelines, patients with infrarenal or juxtarenal abdominal aortic aneurysms (AAAs) measuring > or = 5.5 cm should undergo repair to reduce the risk of rupture. The 5.5-cm-diameter threshold is the size when the AAA rupture rate balances the mortality rates of elective open surgical AAA repair (3%). Endovascular AAA repair (EVAR) is associated with lower perioperative mortality and complication rates compared with open surgical repair. This debate addresses the issue whether the current size threshold for elective AAA repair needs to be lowered in the endovascular era. This paper supports the position that the size threshold for AAA repair should be lowered in the endovascular era.
Paraskevas
Kosmas I
KI
Department of Vascular Surgery, Red Cross Hospital, Athens, Greece. paraskevask@hotmail.com
Mikhailidis
Dimitri P
DP
Andrikopoulos
Vassilios
V
Bessias
Nikolaos
N
Bell
Sir Peter R F
SP
D001012:Aorta, Abdominal / Q000473:pathology; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001019:Aortic Rupture / Q000401:mortality / Q000517:prevention & control / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation; D004108:Dilatation, Pathologic; D017558:Elective Surgical Procedures / Q000401:mortality / Q000592:standards*; D006801:Humans; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D016896:Treatment Outcome