What factors are considered when deciding whether to repair an abdominal aortic aneurysm (AAA)?

Updated: Jan 08, 2019
  • Author: Saum A Rahimi, MD, FACS; Chief Editor: Vincent Lopez Rowe, MD  more...
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Answer

For patients at higher risk, the threshold for repair may be a diameter of 6-7 cm, depending on their condition. At this size, the risk of rupture increases with age. These sizes apply to males of average height (170 cm); again, the threshold may be lower in women.

Thus, the decision to repair an AAA is a complex one in which the patient must play an important role. In many patients, the decision to operate is a balance between risks and benefits. In some very elderly patients or patients with limited life expectancy, aneurysm repair may not be appropriate. In these patients, the consequences of rupture should be frankly discussed. If rupture occurs, no intervention should be performed.

Although surgical repair may not be indicated in an elderly patient (>80 years) with significant comorbidities, the decision whether to intervene should not be based on age alone, even with rupture. The decision is best based on the patient’s overall physical status, including whether the patient has a positive attitude toward the surgical procedure and whether the patient is a candidate for endovascular aneurysm (or aortic) repair (EVAR).

Patients with known cancer that has an indolent course (eg, prostate cancer) may be suitable candidates for aneurysm repair if their estimated survival is 2 years or longer.


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