Question What would the %rate of rupture be per yr?per 5yrs if the aneuryism is 4 cm?
What is the rate risk of the following for (A) open surgery, (B)endovascular:
Infection ED
Blood Clots Spinal Injury
Bleeding Leakage
Kidney Failure Heart Attack
Pneumonia
Injury to colon's blood supply
Answer As an aneurysm enlarges, it can rupture with increasing frequency. Half of patients who rupture their AAA never reach medical attention. And about half of those do not survive treatment. The risk of rupture dramatically increases once an AAA reaches 5 cm. in diameter. Here it is around 25% at 5 years. At 7 cm. the risk of rupture is over 60% at 5 years.therefore around 10% to 20% at 4 cm.
The prevalence of abdominal aortic aneurysms (AAA) is increasing, involving 5% of individuals over 60 years of age
The mortality rate for all ruptured AAA is estimated to be as high as 90%
A new, minimally invasive treatment modality for AAA named endovascular aortic treatment is now offered at UI Hospitals and Clinics, promising a shorter hospital stay, lower morbidity, quicker recovery, decreased cost, and the possibility of outpatient AAA repair
In properly selected patients, the success of deploying these endovascular stents is greater than 90%
The prevalence of AAA appears to be increasing, involving 5% of individuals over 60 years of age. Today's commonly quoted five-year risk rates of AAA rupture range 0 to 2% for aneurysms with diameter below 5 cm, 20% to 25% for aneurysms with diameter 5 to 5.9 cm, 35% for those with diameter 6 to 6.9 cm, and more than 75% for those larger than 7 cm. Most surgeons agree that intervention is indicated when the risk of rupture exceeds the risks of intervention
Unfortunately, most AAAs rupture suddenly. A few patients may experience new severe tearing like back pain, but still not yet be ruptured. A patient with a pulsitile abdominal mass, back pain and low blood pressure has a rupturing AAA until proven otherwise.
A standard operation has proven durability of 20 plus years with very minimal consequences of longterm problems. It does involve an operation with an open repair that typically can require a 6-9 day hospital stay. For most patients, the operative risk is between two and four percent for mortality. The endovascular repair is still investigational, with the endografts still under FDA Review. While an endograft has the potential to shorten hospital stays to 1-2 days, and shorten recovery to only days, there are some issues to consider. Most centers placing Endografts still are reporting 1-2% operative mortalities around the procedure. This is because of patient risk factors, such as coronary artery disease, that cannot be reduced to zero. AAAs repaired by endografting have not been followed by more than 5 years, and this is only the first few placed. Most centers have at best 2 years follow-up. Even then, all endograft patients require expensive testing every three months to confirm the repair is still good. Endografts have developed delayed leaks (called 'endoleak') in up to 15-18% of reported patients. Some endoleaks are treatable, some are not. This has resulted in rupture of the very AAA it was supposed to treat! While this is not common, it remains a long term risk that is poorly defined to those patients with an endograft.
Surgical treatment of AAA has been performed routinely for almost 50 years and is one of our most successful and durable operations. In surgery the diseased part of the aorta is replaced with a Dacron or Teflon graft that is carefuly matched to the normal aorta and sewn in place by the surgeon. While ultimately curative, this is an operation that requires a major abdominal incision and general anesthesia, and the hospital stay averages 7-10 days for most patients. Even after uncomplicated surgery, it is often 6-8 weeks before patients can return to a full and normal life. Recent advances in catheter-based technologies have led to groundbreaking treatments for aortic aneurysmsendovascular grafting technology allows surgeons to repair the AAA by delivering a bypass graft through a small incision in the groin, rather than the traditional major open surgery. The endovascular method, approved by the FDA in the fall of 1999, allows the tightly wrapped graft to be delivered via a catheter (tube) inserted in a groin artery. In the operating room, using x-rays for proper positioning, the graft is secured in place by inflating a balloon to expand the graft to the size needed to prevent blood flow into the aneurysm. For most patients, the hospital stay is only overnight, with a return to work or normal daily activities in about a week. Even patients with multiple medical problems, once thought "too sick to undergo traditional AAA repair," can have their AAA repaired with an endovascular method, and often be home the next day.
Endovascular repair of AAA is being performed routinely A select team of physicians including vascular surgeons and interventional radiologists provide a multidisciplinary approach to treatment and the special skills necessary to handle the most complex problems. If you have an aortic aneurysm and you are in good health, some consideration should be given to elective repair.
Risks are related to several factors, including the experience of the hospital and surgeon and the health of the patient. Patients with a history of heart disease have increased risk, because the leading cause of death associated with surgery is a post-procedure heart attack. If you have coronary artery disease, discuss this with your physician prior to surgery. He/She will probably want to do a thorough evaluation
Blood Clots Spinal Injury
Bleeding Leakage
Kidney Failure Heart Attack
Pneumonia
Injury to colon's blood supply
all the above possible along with infection
Exposure of the abdominal aorta through the left retroperitoneum is
a well accepted technique. Unfortunately, splenic injury is a complication of
this approach that rarely occurs through a mid-line transabdominal incision. In
this series we evaluate the occurrence of splenic injury during left
retroperitoneal aortic surgery.
