Endovascular Evaluation and Treatment of Abdominal Aortic Aneurysms

During Monday morning’s focused symposium on Essentials of Endovascular Therapy, Dr. George Vatakencherry discussed the evaluation and treatment of abdominal aortic aneurysms (AAAs). Starting with the epidemiology of AAAs, he presented statistics on the incidence of probable rupture by diameter, stating that AAAs over 8.0 cm in diameter have a 30% to 40% rupture rate per year.

Dr. Vatakencherry then reviewed the MASS trial (Multicentre Aneurysm Screening Study Group), which took place in 4 U.K. centers. It looked at 67,800 men from age 65 to 74 who were randomized to screening or not; those with an AAA of less than 3 cm diameter had no further follow-up; those with an AAA of 3 to 4.4 cm diameter had annual scans; and those with an AAA of  4.5 to 5.4 cm had a scan every three months. Subjects with AAAs of 5.5 cm or more than 1 cm of growth in 1 year went for repair. At the end of the trial, 27,147 patients had been screened, and 4835 had follow-up scans, leading to 47 fewer deaths.

He also reviewed small aneurysm randomized controlled trial (RCTs), including UKSAT and ADAM (see below). Conclusions of open RCTs state that treatment size should be 5.5 cm for men, and women rupture at a 4-times higher rate at the same size.

Dr. Vatakencherry also discussed additional trials looking at EVAR vs open repair and endovascular vs open repair, as well as additional interventions such as fenestrated abdominal stent grafts and Perc-EVAR.

In conclusion, he stated that clinicians should screen for AAA/incidentals; repair 5.5 cm AAAs in men and 4.5 to 5 cm AAAs in women. Atherosclerosis causes the majority of deaths in these patients (60% to 70%), and long-term follow-up is mandatory.