Immediate repair compared with surveillance of small abdominal aortic aneurysms

Endovascular Repair vs Open Surgical Repair of Abdominal Aortic Aneurysms: Comparative Utilization Trends From 2001 to 2006

“…In all likelihood, a major factor in the restraint that has been shown has been the existence of a clear guideline for when intervention is indicated. Despite the opportunity for self-referral that exists when a patient presents to a surgeon with an AAA, the general agreement that intervention is not warranted until an aneurysm grows to a diameter of 5.5 cm [1][2][3] seems to have been adhered to.…”

“…Most physicians involved in the treatment of this condition now agree that intervention is indicated when an AAA reaches a diameter of Ն5.5 cm [1][2][3]. One of the most dramatic advances in recent years in the field of percutaneous vascular interventions has been the development of endovascular stent grafts, which can be used in the treatment of many (though not all) AAAs.…”

The Impact of Recent European Trials on Abdominal Aortic Aneurysm Repair: Is a Paradigm Shift Warranted?

“…A threshold diameter of 5.5 cm has been the point of separation commonly used in previous trials. Despite the fact that both the United Kingdom Small Aneurysm trial [16] and the US Veterans Administration Aneurysm Detection and Management [17] trial showed no benefit in overall survival to early repair over continued obser- …”

“…However, autopsies are not commonly obtained nowadays and study patients dying outside of a hospital setting in particular may not have a correct cause of death recorded. Thus, AAArelated death, taken alone, is a soft endpoint and one which tends to preserve any initial/perioperative mortality advantage of one method of repair over another [17], as it may well have in the European EVAR trials. One cannot help but wonder what the interpretation of the United Kingdom small aneurysm and Aneurysm Detection and Management trials would have been if AAA-related death had been used as the primary endpoint, rather than all-cause mortality, as currently is the case in the Positive Impact of Endovascular Options for Treating Aneurysms Early and Comparison of Surveillance versus Aortic Endografting for Small Aneurysm Repair small AAA trials of EVAR versus No Rx (rather than OPEN).…”

Current Treatment of Peripheral Arterial Disease

“…Aneurysm size is the single most accurate predictor of the risk of complications. In asymptomatic patients, repair is indicated once the size exceeds 5.5 cm (106). However, in patients with the clinical triad of abdominal and/or back pain, a pulsatile abdominal mass, and hypotension, immediate evaluation is required.…”