title: Technical advances with newer aortic endografts provide additional support to withhold the early endovascular repair of small abdominal aortic aneurysms until it is really needed.
abstract: The idea of early endovascular aortic repair (EVAR) of "small" abdominal aortic aneurysms (AAAs) has gained attention over "watchful waiting," mostly due to the concern for losing the anatomic suitability for endovascular repair over time. Generally, small AAAs have longer, smaller, less angulated necks, and less tortuous iliac arteries than larger ones. Though the borderline anatomic characteristics were assumed to be contraindications for older generation endografts, the modifications of modern devices seem promising to overcome those limitations, in order to treat the small AAAs when reaching the 5.5 cm threshold. Moreover, early endovascular intervention has been proven neither cost effective nor beneficial for the patients' quality of life. This article evaluates the technical progress that could overcome the difficulties of those small AAAs that present technically demanding anatomies, thus advocating endovascular intervention when they reach the diameter threshold.
authors.affiliation: Department of Vascular Surgery, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece. efstratiosgeorg@gmail.com
authors.forename: Efstratios
authors.initials: E
authors.lastname: Georgakarakos
authors.forename: George S
authors.initials: GS
authors.lastname: Georgiadis
authors.forename: Evagelos
authors.initials: E
authors.lastname: Nikolopoulos
authors.forename: George
authors.initials: G
authors.lastname: Trellopoulos
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Kapoulas
authors.forename: Miltos
authors.initials: M
authors.lastname: Lazarides
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D061345:Early Medical Intervention; D057510:Endovascular Procedures / Q000295:instrumentation*; D006115:Greece; D006801:Humans; D011474:Prosthesis Design; D013997:Time Factors; D016896:Treatment Outcome; D057832:Watchful Waiting