Pitfalls and progress in the management of abdominal aortic aneurysms

Abstract

Based on a review of the literature and 241 cases of abdominal aortic aneurysm (AAA) operated at the Mannheim Surgical Clinic, the progress and pitfalls in the management of this lesion are discussed. Progress in diagnosis is based on noninvasive imaging procedures, e.g., ultrasound, which lead to the detection of more aneurysms before they rupture. Ultrasound also plays a role in the observation of small asymptomatic aneurysms in high‐risk patients, helping some to avoid operation as well as rupture. Progress in the treatment of AAA means simplification: rapid clamping of the aorta in case of rupture, minimal dissection, and aneurysmal repair with straight‐tube interposition by the inlay technique. The pitfalls of “trash foot,” colon, or renal ischemia as well as graft infection can be mostly circumvented by observance of technical detail. In this series, the mortality following repair of asymptomatic AAA was 3.7%; for symptomatic aneurysms, it was 8%; and for ruptured aneurysms, it amounted to 55%.

Simultaneous repair of abdominal aortic aneurysm and resection of unexpected, associated abdominal malignancies

“…If operations are staged, and tumor resection is performed first, delaying AAA treatment of a month, there is a potential for aneurysm rupture [5,6]. If AAA repair is performed first and tumor resection is delayed, there is a risk of local and metastatic spread of tumor, whereas there might be an overall increased operatory risk and an increased risk of bacterial graft contamination, if both procedures are simultaneously performed [7,8]. These general principles earn a different importance, according to the different biological and surgical characteristics of tumors that may be encountered.…”

“…The reported experience, although it does not consider the option of endovascular treatment of AAA, which might be appealing in this setting, supports the simultaneous surgical treatment of AAA and several neoplasms. Such attitude spares the patient a second procedure, either abdominal [7,9] or endovascular. Although graft contamination is a real concern in a simultaneous procedure; to our knowledge, no graft sepsis related to such treatment has been reported up to now.…”

“…As left colectomy and anterior resection are at higher risk of intraoperative graft contamination, the possibility of staging the resections, beginning with the one at higher risk of complication, as rupture for a large AAA, over 6-cm diameter, or abdominal occlusion for colon carcinoma. Nevertheless, even when left colectomy for cancer has been simultaneously performed with AAA repair, no related graft infection has been observed [7,8,16,18].…”

Simultaneous total gastrectomy and endovascular repair of an abdominal aortic aneurysm: Report of a case

“…10,11 If AAA repair is performed and tumor resection is delayed, there is risk for interim spread of local and metastatic disease. 12,13 If the procedures are performed simultaneously, the risk of the surgery increases due to both the greater risk of bacterial graft contamination, higher blood loss, and possible stress on the patient due to a longer duration of surgery. These general principles may vary, depending upon the different characteristics of the malignancy that is encountered.…”

Management of concomitant abdominal aortic aneurysm and colorectal cancer

“…2,11 Endovascular AAA repair (EVAR) might lead to better results in the synchronous treatment of CRC and AAA, because it could minimize the risk of graft infection and shorten the period between AAA repair and CRC treatment. 1,[14][15][16][17][18][19] Considering the disparity in therapeutic strategies and the dearth of clear evidence, we conducted a systematic review of the literature and analyzed the reported cases of concomitant CRC and AAA management with a focus on the different treatment options and related therapeutic outcomes.…”