Identifying High-Risk Patients for EVAR

Advanced cross-sectional imaging and enhanced screening efforts have enabled physicians to identify abdominal aortic aneurysms (AAAs) with greater frequency. Several studies have compared the outcomes of open repair with endovascular aneurysm repair (EVAR) for the treatment of AAAs. Although much of the data have indicated that EVAR is associated with significant benefits, there have been concerns as to whether the procedure is a sufficiently low-risk surgery for all patients. Of particular concern is a subset of high-risk patients with prohibitively high mortality. “Every surgery requires a risk-benefit analysis before deciding whether or not to proceed,” explains K. Craig Kent, MD. “Aneurysms are incredibly lethal and have been associated with an 85% chance of death when ruptures occur. Few people make it to the hospital in time, and 50% of those who do have an aneurysm rupture die during emergency surgery. The goal in treating aneurismal disease is to prevent the aneurysm from rupturing. However, the challenge is deciding what aneurysms should be repaired based on individual patient characteristics.” Assessing EVAR in High-Risk Patients EVAR for AAA has been shown to offer significant advantages. As a minimally invasive procedure, EVAR does not always require general anesthesia or ICU admission postoperatively. The procedure also eliminates the need for laparotomy and associated complications, decreases blood loss compared with open repair, and avoids the major perioperative intravenous fluid shifts that are observed with open repair. Moreover, it significantly reduces perioperative morbidity and mortality, compared with traditional open surgery. “Many patients who are at high risk for open repair can be safely treated with endovascular repair.” — K. Craig Kent, MD   According to...