MedifocusHealth

• Surgical risk factors for the individual patient - Patients who have substantial surgical risk factors such as older age and co-morbidities (e.g., heart, kidney, or lung diseases) may experience a higher than average mortality rate for open surgical repair of AAA. For a 70-year old patient, for example, the mortality rate could range from 2% with no risk factors to over 40% with multiple co-morbidities.

• The patient's willingness to comply with the follow-up schedule for continued surveillance of the endovascular graft.

Advantages of Endovascular Aneurysm Repair

Advantages of endovascular AAA repair include:

• Lower perioperative risk because it is less invasive surgery
• Shorter hospitalization
• Shorter recovery time
• Fewer adverse events, particularly cardiac, renal, and pulmonary than for open surgery (estimates range from 30-70% reduction of these complications)
• Lower incidence of erectile dysfunction than open surgery
• Enables individuals who otherwise could not tolerate open surgery with general anesthesia to benefit from elective AAA repair

Complications of Endovascular Aneurysm Repair

The disadvantages of EVAR include:

• Late complications
• High rate of reintervention
• There is no indication of improved survival over open AAA repair
• Population considered eligible is very limited
• Burden on the patient to undergo continual surveillance is very high

Complications that may occur either during or after endovascular repair for abdominal aortic aneurysm include:

• Endoleaks - This is characterized by persistent leakage of blood from fabric tears or from the joints connecting each part of the stent-graft. The blood leaks into the aneurismal sac between the graft and the arterial wall but not into the abdominal cavity. This complication occurs in 10-20% of AAA repairs. There are four types of endoleaks - types I and III are associated with continued expansion and rupture while types II and IV rarely causes adverse effects and may seal themselves.
• Problems with durability of stent-graft
• Later secondary reintervention and/or open repair
• Injury to arteries due to insertion of catheter
• Occlusion of renal or hypogastric arteries due to improper placement of graft
• Injury to kidneys due to toxicity of contrast dyes
• Post-implant syndrome - a syndrome characterized by back pain and fever but without other evidence of infection
• Blood clot formation
• Rupture of aneurysm

If in the course of surgery, the surgeon finds that the anatomy of the patient is more complex than originally anticipated, the surgeon will convert EVAR over to open surgery.

It is important for the individual undergoing elective surgery for abdominal aortic aneurysm to consider carefully the risks and benefits of each type of surgical procedure (open repair or EVAR) as well as to consult closely with their physicians regarding individual risk factors for aspects of both procedures.