Disparate outcome after endovascular treatment of small versus large abdominal aortic aneurysm

Abstract

Outcome after endovascular repair of abdominal aortic aneurysm depends on size; results appear inferior in patients with larger aneurysms. These differences attain importance when choosing between observation and repair, balancing risk for rupture against size-dependent outcome.

Severe structural damage of the seemingly non-diseased infrarenal aortic aneurysm neck

“…and improved survival in patients undergoing endovascular repair of small aneurysms. 41 It has been shown that about 30 elastic lamellae of the aortic media can be nourished by diffusion from the vessel lumen. 42 The healthy human infrarenal aortic media, unlike the thoracic aortic segment, is lacking vasa vasorum.…”

What is the significance of endoleaks and endotension

“…Smaller amounts of mural thrombus in the aneurysm sac also have been found to correlate with device-related endoleaks. Ouriel et al found in a study of 700 patients that patients with a large (>5.5 cm) aneurysm more often developed a late type I endoleak than patients with a small aneurysm [41]. There was no difference in frequency of the type I endoleak seen on intraoperative angiograpgy or postprocedure CT scans.…”

The Evidence for Management of Abdominal Aortic Aneurysms: Lessons Learned from Randomised Controlled Trials

“…A constant finding in these trials has been that a significant proportion of AAAs under ultrasonographic surveillance come to require repair within the duration of the study 26,39 . This, taken together with the low but present annual risk of rupture has lead to differing interpretations of the results of these trials with some authors still advocating in favour of early repair of small AAA using the justification that a policy of early EVAR is as safe as a policy of US Surveillance 42 . To date there is no objective data to recommend either open or endovascular repair of smaller AAAs over a policy of watchful waiting and US surveillance.…”