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Feature Article

Abdominal aortic aneurysms. Part 2: Surgery and postoperative care

David Goh, Jason Chuen

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Abstract

Endovascular stent graft technology has become the first-line and default surgical treatment of abdominal aortic aneurysms by many vascular surgeons throughout Australia and internationally. This second part of a two-part article discusses the surgical treatments available for abdominal aortic aneurysm repair, postoperative care and long-term follow up.

Key Points

  • Repair of an abdominal aortic aneurysm (AAA) is considered when its size reaches 5.5 cm in men or 5.0 cm in women.
  • Endovascular aneurysm repair (EVAR) is less invasive than open surgery; however, there are anatomical limitations to its application.
  • Open surgical repair of a AAA is signi cantly more invasive and carries more operative and short-term risk than EVAR; however, it can be used to treat a wider range of AAAs and has long-term data supporting its use.
  • Follow up of postoperative AAA repair should be lifelong, irrespective of surgical technique.
  • EVAR requires stringent follow up involving lifelong imaging surveillance because stent grafts can fail at any stage postoperatively. Secondary intervention is required in up to 26% of patients at 15 years after EVAR.
  • Endoleaks from EVAR can be life-threatening and affected patients should be referred to a vascular surgeon immediately.

    Picture credit: © Zephyr/SPL

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