Emerging strategies to treat ruptured abdominal aortic aneurysms.
Population screening programmes and a falling population prevalence of smoking have led to a declining incidence of ruptured abdominal aortic aneurysms in men. However, ruptured abdominal aortic aneurysms remain a common vascular surgical emergency, with an increasing proportion of ruptures being in women. About one quarter of the ruptures have a juxta-renal aneurysm and are more challenging to repair using endovascular technologies. Endovascular technologies may not reduce the overall mortality, compared with open surgical repair, but appear to offer early benefits with respect to patient quality of life at acceptable cost. Challenges over the next 5 years include widening the access to repair, developing an accurate bedside risk scoring tool, as well as optimising strategies for pre-operative resuscitation, standardising peri-operative care and the management of post-operative complications.
a St George's Vascular Institute , St George's Hospital , London , UK.
Janet T
JT
Powell
a St George's Vascular Institute , St George's Hospital , London , UK.
Robert J
RJ
Hinchliffe
D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D001019:Aortic Rupture / Q000209:etiology / Q000401:mortality / Q000601:surgery; D057186:Comparative Effectiveness Research / Q000706:statistics & numerical data; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control* / Q000523:psychology; D011788:Quality of Life; D020379:Risk Adjustment; D058017:Vascular Grafting / Q000009:adverse effects / Q000379:methods / Q000401:mortality
abdominal aortic aneurysm rupture; access; endovascular repair; morphology; peri-operative management; survival