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A Journal on Vascular and Endovascular Surgery
Italian Journal of Vascular and Endovascular Surgery 2008 March;15(1):55-62
Management of abdominal aortic aneurysms and renal artery disease
Batt M., Rovani G., Thevenin B., Bouillanne P.-J., Jean-Baptiste E., Hassen-Khodja R., Declemy S.
Department of Vascular Surgery Hôpital Saint Roch Université de Nice-Sophia Antipolis, Nice, France
The prevalence of association of an abdominal aortic aneurysm (AAA) with a hemodynamic stenosis of the renal artery (RAS) varies from 2% to 8 %. The indications for treatment of AAA are well established; in particular, a diameter of 55 mm is considered the threshold starting at which treatment must be envisaged. Endovascular aneurysm repair (EVAR) is increasingly common, but only 50% of AAA present the anatomic criteria compatible with EVAR. The indications for the treatment of RAS are still a subject of discussion. However, the role of surgery has decreased dramatically in favor of endovascular repair. Open and/or endovascular repair of AAA and RAS must take account of the surgical risk for the patient; the anatomic risk must also be analyzed for endovascular repair. Simultaneous open repair should only be proposed for patients who are good surgical candidates. Surgery is indicated when the anatomic characteristics of the AAA preclude endograft placement (high anatomic risk): in certain situations, open repair is indispensable. The results of concomitant surgery are comparable to those of isolated surgery of AAA. Finally, open repair is indicated when the AAA is associated with a complex RAS, and after failure, development of complications or restenosis of RAS angioplasty. EVAR should be reserved for AAA with favorable anatomic features (low anatomic risk). While the surgical risk must also be taken into consideration when deciding on the treatment strategy, it is less important than the anatomic risk. Endovascular repair of the AAA and the RAS can be performed sequentially or concomitantly.