Additional evidence suggesting that the size threshold for elective abdominal aortic aneurysm repair may need to be lowered in the endovascular era.

摘要

In 2009, I proposed that the size threshold for elective abdominal aortic aneurysm (AAA) repair may need to be lowered in the endovascular era.1 The current 5.5-cm-diam-eter threshold is the size when the AAA rupture risk becomes greater than the peri-operative mortality of open surgical repair. Since endovascular aneurysm repair (EVAR) is associated with lower perioperative mortality and complication rates compared with open surgical repair,2I hypothesized that it may be beneficial to treat smaller AAAs with EVAR. Two randomized controlled trials. Comparison of surveillance vs. Aortic Endografting for Small Aneurysm Repair (CAESAR)2 and Positive Impact of endoVascular Options for Treating Aneurysms earLy (PIVOTAL),3 were designed to compare EVAR versus surveillance in subjects with small AAAs (4.1-5.4 cm in CAESAR2 and 4-5 cm in PIVOTAL3).