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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
A Journal on Vascular and Endovascular Surgery
Italian Journal of Vascular and Endovascular Surgery 2007 March;14(1):33-47
Abdominal aortic aneurysms: current opinions, management and future trends
Piffaretti G., Tozzi M., Lomazzi C., Rivolta N., Riva F., Maida S., Caronno R., Castelli P.
Unit of Vascular Surgery Department of Surgery University of Insubria, Varese, Italy
Irrespective of the definition, the underlying problem in aneurysmal disease is weakening of the aortic wall, resulting in progressive dilatation and, if left untreated, eventual aortic rupture. With an aging population, the incidence and prevalence of abdominal aortic aneurysms (AAAs) is certain to rise. Risk factors included smoking, high plasma cholesterol concentrations, hypertension, and family history. Most AAAs are asymptomatic: small aneurysms now account for approximately 50% of all clinically recognized abdominal aortic aneurysms: this is a focal point because many physicians are uncertain about the appropriate management. Clinical studies to examine the role of medical therapy in slowing aneurysm progression have been limited to date, but some authors suggest the use of statins and β-blockers to attenuate aneurysm growth. AAAs should undergo elective repair when the risk of rupture is sufficiently high to justify the risk of surgery: thus, each patient should have an individual decision based on the estimated risk of aneurysm rupture, the perceived operative risk and overall life expectancy. The mortality rate for elective open surgery is only 2-6%, but is still ranging between 15-90% for ruptured aneurysms: these figures underscore the importance of early diagnosis, whose benefits have been highlighted in several prospective studies. A growing body of evidence indicates that elective conventional aneurysm repair has become an extremely safe procedure in recent years for all infrarenal aneurysms. By contrast, endovascular repair is dependent upon and limited by aneurysm morphology. Comparison of conventional open AAA repair and endovascular repair is subject to several flaws, such as patient selection bias, learning curve bias in favour of open repair, and variation in the reporting standards. Moreover, technical and short-term results of the new both fenestrated and branched techniques have been promising but anedoctal. Thus, recently surgical teams have entered the new field of laparoscopic or robot-assisted aortic surgery.