Perioperative management - Abdominal Aortic Aneurysm - Endovascular Therapy

Asymptomatic: a rapid increase in size (> 4mm 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: every aneurysm rupture is a life-threatening situation and represents the absolute indication for surgery in all patients.

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

Contrast agent intolerance in

• Allergy
• Renal insufficiency or
• Hyperthyroidism

• Contrast-enhanced abdominal CT (Angio-CT) for visualization of aneurysm size and morphology
• additional intra-arterial angiography in case of clinical suspicion of AVK in the course of the pelvic or renal arteries
• internal medicine evaluation 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 in the context of fluoroscopy
• Provision of red blood cell concentrates depending on GC and initial Hb

• Conversion (“open” aneurysm exclusion by laparotomy)
• Circulatory disturbances of the legs (amputation),
• of the bowel (artificial bowel outlet) and
• of the kidneys (dialysis requirement)
• Stroke
• Heart attack
• Death