Abdominal aortic aneurysms
KC Kent - New England Journal of Medicine, 2014 - Mass Medical Soc
KC Kent
New England Journal of Medicine, 2014•Mass Medical SocKey Clinical Points Abdominal Aortic Aneurysms Abdominal aortic aneurysms are usually
asymptomatic until they rupture, with an ensuing mortality of 85 to 90%. Symptomatic
patients require urgent repair. US Preventive Services Task Force recommendations support
screening in men 65 to 75 years of age with a history of smoking and selective screening in
men 65 to 75 years of age without a smoking history, although the optimal cohort to be
screened remains controversial. The usual threshold for elective repair is an aortic diameter …
asymptomatic until they rupture, with an ensuing mortality of 85 to 90%. Symptomatic
patients require urgent repair. US Preventive Services Task Force recommendations support
screening in men 65 to 75 years of age with a history of smoking and selective screening in
men 65 to 75 years of age without a smoking history, although the optimal cohort to be
screened remains controversial. The usual threshold for elective repair is an aortic diameter …
Key Clinical Points
Abdominal Aortic Aneurysms
- Abdominal aortic aneurysms are usually asymptomatic until they rupture, with an ensuing mortality of 85 to 90%.
- Symptomatic patients require urgent repair.
- U.S. Preventive Services Task Force recommendations support screening in men 65 to 75 years of age with a history of smoking and selective screening in men 65 to 75 years of age without a smoking history, although the optimal cohort to be screened remains controversial.
- The usual threshold for elective repair is an aortic diameter of 5.5 cm in men and 5.0 cm in women.
- Endovascular repair results in lower perioperative morbidity and mortality than open repair, but the two methods are associated with similar mortality in the long term (8 to 10 years).
- Patients treated with endovascular repair require long-term surveillance owing to a small risk of aneurysm sac reperfusion and late rupture.
- Decisions regarding prophylactic repair — whether to pursue it and, if so, what type of repair to perform — must take into account anatomy (not all patients have anatomy amenable to endovascular repair), operative risk, and patient preference.
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