Abstract
Two methods of repair are currently available for an abdominal aortic aneurysm (AAA),
open aneurysm repair and endovascular aneurysm repair (EVAR). The decision making
depends on the balance of risks and benefits. The treating physician must take into
account the patient's life expectancy, the patient's fitness, the anatomic suitability
that makes endovascular repair possible, and finally the patient's preference. The
patient's fitness is an important variable predicting the outcome of AAA surgical
reconstruction. The hypothesis is that the impact of risk factors upon perioperative
mortality might differ between patients undergoing open repair and endovascular repair.
The purpose of this review article is to investigate whether fitter patients with
a large AAA benefit more from having endovascular rather than open repair. According
to the available data, there is emerging evidence that patients at high medical risk
for open repair may benefit from EVAR while in low risk patients with suitable anatomy
for EVAR, both techniques have similar effects. There is rising evidence that a patient
with ruptured AAA would benefit more from an endovascular procedure if eligible, and
thus fitness in such emergencies is not the first priority but anatomical suitability
for EVAR.
Keywords
abdominal aortic aneurysm - endovascular treatment - fitness
