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• Gastrointestinal ischemia and/or dysfunction - Temporary dysfunction or paralysis of the small or large intestines often due to manipulation of the intestines during surgery or fluid retention.

• Erectile Dysfunction - Open abdominal aortic aneurysm repair has been reported to be associated with impairment of sexual function in men, most likely because of autonomic nerve injury and pelvic blood flow changes

• Graft infection - This may occur months to years following surgery and is associated with significant morbidity and mortality. Prophylactic use of antibiotics prior to surgery is helpful in reducing the risk of this complication.

Estimates of mortality during or following open repair for abdominal aortic aneurysm is related to experience of the surgeon and ranges from 4% mortality for surgeons who have performed a high volume of open repair to 8% for those with a low volume of experience with open repair.

Endovascular Aneurysm Repair (EVAR)

Endovascular aneurysm repair (EVAR) is usually reserved for a limited selection of patients, including:

• Individuals with AAA who cannot tolerate open surgery due to concurrent medical conditions
• Individuals who are elderly

Endovascular aneurysm repair is a newer and less invasive surgical technique as compared with open AAA repair and is usually done under regional (spinal) or local anesthesia. Using this technique, the surgeon creates an incision in the groin area and a catheter containing the prosthetic graft within a metal (mesh) stent is advanced through the femoral artery under radiological guidance (ultrasound or X-ray) up to the area of the aneurysm. When the stent-graft is correctly inflated and anchored into place, the aneurysm is shielded from blood flow and may even shrink over time. This procedure is followed by a temporary period in the intensive care unit and hospitalization of approximately one week.

The stent-graft provides an alternative pathway for blood to flow through the aorta without filling the aneurysm, which reduces pressure on the aneurysm and reduces the risk of bursting. The proximal end of the graft (end closer to the heart) is placed just below the lower of the two renal arteries and the distal ends usually extend into the two iliac arteries in each leg (bifurcated stent). The Food and Drug Administration (FDA) to date has approved two stents to be used for endovascular repair of AAA - the Guidant Ancure stent-graft and the Medtronic AneuRx stent graft. They differ in the materials from which they are made and how they attach to the arterial walls.

Factors that are taken into consideration to determine if patients with an abdominal aortic aneurysm may be eligible candidates for EVAR include:

• The presence of other underlying medical (comorbid) conditions
• Anatomy of the blood vessels (e.g., if they are unusually positioned or very curved)
• Experience of the surgeon
• Experience of the hospital staff participating in this procedure
• Patient's life expectancy following surgery
• Level of risk if open surgery was performed
• Presence of debris (e.g., calcifications or fatty deposits) in the segment of the aorta immediately above the aneurysm
• If the individual meets the specific criteria for inclusion determined by the manufacturer of the EVAR equipment