title: Peripheral arterial aneurysms: open or endovascular surgery?
abstract: Peripheral arterial aneurysms are uncommon; for some aneurysm types, data are limited to case reports and small case series. There is no Level A evidence in most cases to determine the choice between open or endovascular intervention. The evolution of endovascular technology has vastly improved the armamentarium available to the vascular surgeon and interventionalists in the management of these rare and unusual aneurysms. The choice of operative approach will ultimately be determined on an individual basis, dependent on the patient risk factors, and aneurysm anatomy. After consideration, some aneurysms (femoral, subclavian, carotid and ECAA) fare better with an open first approach; renal, splenic and some visceral artery aneurysms do better with an endovascular first approach. In our practice PAAs are treated with an endovascular first approach. For these rare conditions, both open and endovascular therapy will continue to work in harmony to enhance and extend the capabilities of modern surgical management.
authors.affiliation: Westmead Hospital, University of Sydney Medical School, Sydney, NSW 2145, Australia. irwin.mohan@doctors.org.uk
authors.forename: Irwin V
authors.initials: IV
authors.lastname: Mohan
authors.forename: Michael S
authors.initials: MS
authors.lastname: Stephen
mesh_terms: D000783:Aneurysm / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D057510:Endovascular Procedures / Q000009:adverse effects; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply*; D018579:Patient Selection; D012307:Risk Factors; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*; D014781:Viscera / Q000098:blood supply*
keywords: AAA; Bypass; CA; CAA; CFA; CHA; CHAA; CT; CTA; ECAA; EPAR; EVAR; Endovascular Aneurysm Repair Trial; Endovascular surgery; FAA; FDS; GDA; GDAA; HAA; ICA; MRA; MRI; Management options; OR; Open surgery; PAA; PDA; PDAA; PFA; PFAA; PTFE; Peripheral arterial aneurysms; RAA; Recommendations; SAA; SCA; SCAA; SE; SFA; SFAA; SMA; SMAA; Stents; TIA; TOS; US; VAA; abdominal aortic aneurysm; coeliac axis/artery; coeliac axis/artery aneurysm; common femoral artery; common hepatic artery; common hepatic artery aneurysm; computerized tomographic angiography; computerized tomography; endovascular popliteal aneurysm repair; expanded polytetrafluoroethylene; extracranial carotid artery aneurysm; femoral artery aneurysm; flow diverting stent; gastroduodenal artery; gastroduodenal artery aneurysm; hepatic artery aneurysm; internal carotid artery; magnetic resonance angiography; magnetic resonance imaging; odds ratio; pancreaticoduodenal artery; pancreaticoduodenal artery aneurysm; popliteal artery aneurysm; profunda femoris artery; profunda femoris artery aneurysm; renal artery aneurysm; splenic artery aneurysm; standard error; subclavian artery; subclavian artery aneurysm; superficial femoral artery; superficial femoral artery aneurysm; superior mesenteric artery; superior mesenteric artery aneurysm; thoracic outlet syndrome; transient ischaemic attack; ultrasound; visceral artery aneurysm