Continuing Education in Anaesthesia Critical Care and Pain | Volume 4 Number 3 | 2004
Continuing Education in Anaesthesia, Critical Care & Pain | Volume 4 Number 3 2004 © The Board of Management and Trustees of the British Journal of Anaesthesia 2004
Endovascular abdominal aortic aneurysm repair
Department of Anaesthesia, Wythenshawe Hospital, South Manchester University, Hospitals Trust, Southmoor Road, Manchester, M23 9LT
Department of Anaesthesia, Wythenshawe Hospital, South Manchester University, Hospitals Trust, Southmoor Road, Manchester, M23 9LT
Tel: 01612 916420, Fax: 01612 916421, E-mail: marie.oliver{at}smtr.nhs.uk (for correspondence)
Around two-thirds of abdominal aortic aneurysms (AAA) are incidental discoveries during the investigation of backache, hip pain or urinary tract complaints. They are much more common in men than women (5:1) and account for 2% of all deaths in men aged >60 yr. Open surgical repair of the aneurysm is considered as the standard, traditional method of treatment. Surgery is recommended when the AAA exceeds 55 mm in anteroposterior diameter as measured by ultrasound scan. The risk of spontaneous rupture depends on aneurysm size, ranging from <1% per annum for AAA <55 mm diameter to >17% per annum for aneurysms >60 mm diameter. Ninety per cent of AAAs are located distal to the renal arteries.
Endovascular repair of an aortic aneurysm using an in-situ prosthetic graft was suggested as a technique in 1969 by Dotter, but was only first performed successfully by Parodi and colleagues in 1990. Over the last 10 yr, the availability of endovascular stent grafts has provided an alternative treatment for patients with AAA, especially the elderly with significant co-existing medical conditions. Endovascular repair is much less invasive. However, it is challenging technically and requires a multidisciplinary approach.
During endovascular surgery, an aortic stent graft is passed via the femoral arteries through the aortic lumen to fit tightly above and below the AAA. The aim is to exclude the aneurysm sac from the systemic circulation, thereby decreasing or eliminating the risk of future rupture. The procedure is performed through incisions in one or both groins; no laparotomy is required. However, certain anatomical considerations apply.