Surgery for aortic aneurysms

Abdominal aortic aneurysm (AAA) is a dilatation of the infra-renal abdominal aorta to greater than 3 cm. Population screening is offered to men in their 65th year in the UK. Patients with small AAAs (<5.5 cm) are entered into surveillance programs and should have cardiovascular risk factors managed aggressively. AAA ≥5.5 cm diameter should be considered for repair to prevent rupture. Endovascular aneurysm repair (EVAR) has lower perioperative mortality than open repair and is first line treatment in many centres with an elective mortality rate <1% in the UK. Ruptured AAA can be treated with open or endovascular approaches but the mortality rate for intervention remains in excess of 35%. Developments in endovascular technology allow treatment of juxta-renal, aorto-iliac and thoracoabdominal aneurysms, but should be thoroughly investigated in well designed clinical trials before introduction to routine clinical practice.