Should aortography be used routinely in the elective management of abdominal aortic aneurysm?

Multicenter prospective study of nonruptured abdominal aortic aneurysms. I. Population and operative management

“…Patients having this study as part of the surgeon's "routine" evaluation did not have fewer operative or thromboembolic complications or a lower mortality rate than patients not receiving routine angiography. Because the extent of AAA and associated diseases can also be evaluated with the combination of ultrasound and CT scanning and since the benefits of"routine" angiography have not been demonstrated, use of angiography is justified in selected cases, as suggested by Nuno et al 23 and Papanicolaou et al 24 In this series of nonruptured AAA, 6% were 4.5 cm or less and 14% were less than 5.0 cm, reflecting a conservative approach to the management of relatively small aneurysms; however, the management of small aneurysms still remains controversial. On one hand, Hollier as advises operation in virtually all cases, arguing that Szilagyi, Elliott, and Smith 26 reported that 28% of patients considered "unfit" for surgery died of rupture, and that Darling a7 observed that 18% of ruptured aneurysms were less than 5 cm.…”

Value of Routine Computed Tomography in the Preoperative Assessment of Abdominal Aneurysm Replacement

“…of correct US predictions 23 13 CIAs: common iliac arteries. surgery has been advocated by many in the past [9,[25][26][27], although others have argued for its selective use only [28,29]. Preoperative demonstration of the distal extension of the aneurysm and associated aneurysmal or obstructive disease of the iliac and femoral systems allows selection of the optimal level of the distal graft anastomosis and enables selection of necessary additional reconstructive procedures on the femoral system, although some surgeons contend that significant aneurysmal or stenotic involvement of the common iliac arteries is easily determined at surgery.…”