Perioperative management - Abdominal aortic aneurysm - Endovascular therapy

Asymptomatic: a rapid increase in size (> 4 mm per year) or a transverse diameter of > 5 cm are clinical decision criteria for surgery; in women, smaller diameters are already at risk of rupture.

Symptomatic: any aneurysm rupture is a life-threatening situation and represents the absolute indication for surgery in all patients.

Note: Mortality for emergency procedures: > 40 %, for elective procedures: approx. 3 – 5 %

Contrast agent intolerance in

• Allergy
• Renal insufficiency or
• Hyperthyroidism

• Contrast-enhanced abdominal CT (angio-CT) to visualise aneurysm size and morphology
• additional intra-arterial angiography in case of clinical suspicion of peripheral arterial occlusive disease along the course of the iliac or renal arteries
• internal medicine work-up to assess operability (ECG, chest X-ray, carotid duplex, if necessary stress ECG, echocardiography, myocardial scintigraphy, coronary angiography to exclude CAD)

• Orthograde bowel irrigation the day before to improve image quality during fluoroscopy
• Provision of packed red blood cells depending on general condition and baseline Hb

• Conversion (“open” aneurysm exclusion by laparotomy)
• Circulatory disturbances of the legs (amputation),
• of the bowel (stoma) and
• of the kidneys (need for dialysis)
• Stroke
• Myocardial infarction
• Death