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Clinical features and indications for AAA surgery 

Clinical features and indications for AAA surgery
Chapter:
Clinical features and indications for AAA surgery
Author(s):

Stuart W. Grant

and Charles N. McCollum

DOI:
10.1093/med/9780199658220.003.0048
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date: 23 September 2019

Most abdominal aortic aneurysms (AAA) are asymptomatic; an increasing number are detected through screening programmes. Ultrasound imaging is used for population screening and AAA surveillance with computed tomography angiography (CTA) to plan repair. CTA and duplex ultrasound are used for surveillance following endovascular AAA repair (EVAR). The aim of elective AAA repair is to improve survival by preventing aortic rupture. The decision to use elective repair is based on a balance of risk between the mortality from repair and the risk of aortic rupture. In the future, the decision to intervene will be better individualized, based on patient factors that influence survival. Long-term survival is equivalent for open repair and EVAR. Short-term increased risks of open repair need to be weighed against the long-term efficacy of EVAR in preventing aortic rupture. EVAR is increasingly used to treat ruptured AAA but this is yet to be justified by clinical trial evidence.

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