When not to operate for abdominal aortic aneurysms

Abstract

Refinement in anaesthetic and surgical techniques for repair of abdominal aortic aneurysms has significantly reduced the mortality associated with treating this condition. Endovascular techniques have further pushed back the frontiers for the treatment of aortic aneurysms, and higher risk patients are now being treated under local or regional anaesthesia. The question of when not to offer intervention is becoming more and more difficult. Age is not a bar to aneurysm surgery in a patient who is physically fit; but the risk and benefit of intervention must be carefully evaluated for each patient on an individual basis, and risk calculation must be evidence based. Contraindications to aneurysm surgery are relative and few and include: small aneurysms (<5.5 cm), a co-morbidity that increases surgical risk by >10% and a life expectancy of <1 year. Endovascular graft technology is rapidly advancing, but until the long term results of endovascular repair of aortic aneurysms are proven, the indications for intervention should be the same as for open repair.