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ABDOMINAL AORTIC ANEURYSMS
Italian Journal of Vascular and Endovascular Surgery 2006 September;13(3):155-61
Copyright © 2006 EDIZIONI MINERVA MEDICA
Optimizing abdominal aortic aneurysms therapy by assessing probability of rupture versus risks of prophylactic repair: a review
Teufelsbauer H. 1, Wolff K. S. 1, Wibmer A. 1, Prusa A. M. 1, Sahal M. 1, Polterauer P. 1, Huk I. 1, Lammer J. 2, Kretschmer G. 1
1 Department of Vascular Surgery Medical University of Vienna, Vienna, Austria 2 Department of Angiography and Interventional Radiology Medical University of Vienna, Vienna, Austria
In view of the two treatment modalities of abdominal aortic aneurysms (AAAs), open repair and endovascular management, this review offers evidence based decision criteria in optimizing the therapeutical strategy. It was intended to present information on how to select an appropriate therapy for each individual patient. Special emphasis was laid on the two obviously most important outcome predictors, risk of rupture on one hand and operative mortality on the other one. In the first part we discuss the incidence and impact of the various known risk factors, followed by the natural history of aortic aneurysms and the description of historical treatment. Respective results after the treatment of ruptured aneurysms using open or endovascular repair are presented, followed by a comparative evaluation of both treatment options in elective use. Latest publications as well as own experiences are compared, although the electively treated patients are difficult to compare due to different profiles in comorbidities. An innovative statistical approach was employed to evaluate the two treatment options with clearly different operative stress. In conclusion, favorable results of AAA therapy are achieved by properly assessing the risk of rupture against the risk of prophylactic repair in the individual patient. By tailoring the optimal treatment concept – open repair versus endovascular treatment – adjusted to the patient’s individual risk profile an optimization of therapy is possible.