Elective abdominal aortic aneurysm (AAA) repair

Surgical treatment of an abdominal aortic aneurysm (AAA) is associated with increased risk of mortality. The 30-day mortality risk in open repair is between 4% and 5% while in endovascular repair this figure is between 1% and 2% (1).

Repairing unruptured aneurysms - when to consider repair (2)

Consider aneurysm repair for people with an unruptured abdominal aortic aneurysm (AAA), if it is:

• symptomatic
• asymptomatic, larger than 4.0 cm and has grown by more than 1 cm in 1 year (measured inner-to-inner maximum anterior-posterior aortic diameter on ultrasound)
• asymptomatic and 5.5 cm or larger (measured inner-to-inner maximum anterior-posterior aortic diameter on ultrasound)

Open surgical repair, standard endovascular aneurysm repair or conservative management

• open surgical repair should be offered for people with unruptured AAAs meeting the criteria * unless it is contraindicated because of their abdominal copathology, anaesthetic risks, and/or medical comorbidities
• consider endovascular aneurysm repair (EVAR) for people with unruptured AAAs who meet the criteria * and who have abdominal copathology, such as a hostile abdomen, horseshoe kidney or a stoma, or other considerations, specific to and discussed with the person, that may make EVAR the preferred option
• consider EVAR or conservative management for people with unruptured AAAs meeting the criteria * who have anaesthetic risks and/or medical comorbidities that would contraindicate open surgical repair

* Consider aneurysm repair for people with an unruptured abdominal aortic aneurysm (AAA), if it is:

• symptomatic
• asymptomatic, larger than 4.0 cm and has grown by more than 1 cm in 1 year (measured inner-to-inner maximum anterior-posterior aortic diameter on ultrasound)
• asymptomatic and 5.5 cm or larger (measured inner-to-inner maximum anterior-posterior aortic diameter on ultrasound)

Reference:

• (1) Keisler B, Carter C. Abdominal aortic aneurysm. Am Fam Physician. 2015;91(8):538-43.
• (2) NICE (March 2020).Abdominal aortic aneurysm: diagnosis and management