Endovascular and surgical treatment of abdominal aortic aneurysms

Aneurizme abdominalne aorte javljaju se uglavnom u dobi od 50-85 godina. Češće su kod muškaraca nego žena. Pušenje se smatra najznačajnijim faktorom rizika. Većina aneurizama je asimptomatska ili su simptomi nespecifični, poput boli u abdomenu ili osjećaja pulsirajuće mase u abdomenu. Zato se najčešće pronađu slučajno tijekom neke druge dijagnostičke pretrage, poput ultrazvuka abdomena. Za svaku aneurizmu abdominalne aorte postoji rizik rupture, koja može završiti smrtno. Zato se sve aneurizme veće od 5,2 cm kod žena i 5,5 cm kod muškaraca moraju liječiti endovaskularno ili kirurški. Endovaskularno liječenje (EVAR) povezano je s nižom perioperativnom smrtnošću, pogodno je za brzi popravak rupturiranih aneurizama i može se izvesti u lokalnoj anesteziji. Ali isto tako ima i neka ograničenja, poput anatomskih varijacija vrata aorte ili okluzivne bolesti ilijačnih arterija i ilijačnih aneurizama. Takva stanja mogu biti indikacija za otvoreno kirurško liječenje. Postoperativne komplikacije grafta su češće nego kod otvorenog kirurškog zahvata. Otvoreno kirurško liječenje nema anatomskih ograničenja i omogućuje vizualizaciju ostalih struktura, osim aneurizme. Iako je otvoreni popravak povezan s češćim ranim komplikacijama nakon zahvata i višom stopom mortaliteta od EVAR-a, ima bolje dugoročne ishode, poput manje potrebe za reintervencijama. Preferira se u mlađih pacijenata s niskim operativnim rizikom. Pošto svaki pacijent treba biti individualno tretiran, odluka o tipu zahvata treba biti donesena temeljem karakteristika same aneurizme i pacijentovog općeg stanja.Abdominal aortic aneurysms (AAA) occur mostly at 50-85 years of age. They are more frequent in men than in women. Smoking is considered as the most important risk factor. Most of AAAs are asymptomatic or with non-specific symptoms, like abdominal pain or feeling a pulse in the abdomen. That is why they are usually diagnosed accidentally while doing some other test, like abdominal ultrasonography. For every AAA there is a risk of rupture, which can end fatally. Therefore all AAAs bigger than 5,2 cm in women and 5,5 cm in men should be treated endovascularly or surgically. Endovascular treatment (EVAR) is associated with lower perioperative mortality, it is suitable for fast repair of ruptured AAAs and can be performed with local anesthesia. But it also has some limitations, like anatomic variations of the aortic neck or iliac occlusive disease and iliac aneurysms. Such conditions can be an indication for open surgical repair. Postoperative graft-related complications are more often. Open surgical treatment has no anatomic limitations and provides visualization of other non-aneurysmatic structures. Although open repair is associated with more frequent early complications after treatment and a higher mortality rate than EVAR, it has a better long-term outcome, such as less need for reintervention. It is prefered for younger patients with low operative risk. Since every patient should be treated individually, the type of treatment should be decided based on AAA characteristics and patient's general condition