REVIEW   

Italian Journal of Vascular and Endovascular Surgery 2018 March;25(1):18-24

DOI: 10.23736/S1824-4777.17.01322-5

Copyright © 2017 EDIZIONI MINERVA MEDICA

lingua: Inglese

Indications for open AAA repair in the current advanced endovascular era

Ulrich RONELLENFITSCH, Carola M. WIEKER, Dittmar BÖCKLER ✉

University Hospital Heidelberg, Department of Vascular and Endovascular Surgery, Heidelberg, Germany

After the introduction of endovascular aortic aneurysm repair (EVAR) in the 1990s, the treatment of abdominal aortic aneurysms (AAA) has gradually shifted from open repair (OR) to EVAR. Given its reduced invasiveness with the avoidance of laparotomy and general anesthesia, shorter operation times, less blood loss and lower postoperative pain levels, the latter is now considered the preferred treatment modality by many vascular surgeons. Advanced techniques such as fenestrated or branched EVAR have now made aneurysms with a complex anatomy and juxtarenal aneurysms amenable to endovascular treatment, too. However, even in this “advanced endovascular era,” a number of scenarios remain in which OR seems the preferable approach. These scenarios include anatomic configurations considered unsuitable for EVAR, particularly AAA with an insufficient landing zone requiring stent-graft placement out of instructions for use, concerns about long-term outcome after EVAR, patient preferences, specific requirements in emergency situations, mycotic AAA, and conversion after early or delayed failure or infection of EVAR. In this review article the pertinent evidence for OR in these indications is presented. It shows that in all of these scenarios, OR can be done with favorable outcomes. Careful patient selection and a weighing of risks and benefits are crucial.

KEY WORDS: Aortic aneurysm, abdominal - Surgical procedures, operative - Endovascular procedures