Abdominal Arterial Aneurysms

Arterial aneurysms present both diagnostic and therapeutic challenge since they are asymptomatic and most are difficult to diagnose by clinical exam. Because of which their recognition and referral to vascular surgeon is significantly delayed. When diagnosed they should be repaired (with proper indications) BEFORE they become symptomatic and this yields excellent results as opposed to symptomatic aneurysms which cause significant mortality and morbidity.

Aneurysms can be multiple and certain aneurysms (popliteal, femoral) are more likely to be accompanied by aneurysms at other sites. About 40% 0f patients with abdominal aortic aneurysm (AAA) have aneurysmal iliac arteries. The conventional treatment for such pathologies has been open surgical repair, which involves trans-abdominal surgery, exposure of the aneurysm, cross-clamping the aorta, resection of the aneurysm, and placement of graft prosthesis. Endovascular AAA repair developed as a minimally invasive alternative to such a morbid procedure in patients with suitable anatomy. It has revolutionizing the way complex vascular pathologies are treated in recent times.

Many of these can be treated in a single stage, sparing the patient of multiple procedures. Endovascular repair yields excellent results in selected patients and nearly as good as open surgery, perhaps with less morbidity and mortality. But the cost remains high compared to surgery

Continuing with our previous experiences with endovascular repair of aneurysms, we see that the majority of patients with aneurysmal disease can be treated with endovascular techniques, thus resulting in shorter hospital stays and decreased morbidity and mortality rates compared to open repair. The inherent disadvantages of this approach however are that it is very much more expensive, requires long-term duplex monitoring but may be a reasonable option for selected patients with suitable anatomy for whom the risk/benefit ratio favours endovascular repair and with growing experience, the horizon has rapidly expanded and is progressively replacing open surgical repair for the treatment of aneurysms.

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