FJVIS 5. An Endovascular Approach Is Safe and Effective in the Treatment of Abdominal Aortic Aneurysms Detected by the National Abdominal Aortic Aneurysm Screening Programme

Abstract

The National Abdominal Aortic Aneurysm Screening Programme commenced in England in 2009 and completed implementation in 2013. Its aim was to reduce the rate of death due to ruptured aneurysm in men. The objective of this study was to report on the outcomes for all patients treated for a screen-detected aneurysm at this institution. Patients who underwent repair of a screen-detected aneurysm between February 2010 and 2019 were identified from prospectively kept records held by the local screening program. Preoperative, perioperative, and postoperative details were collected from case notes and online hospital records. There were 113 men who underwent repair of a screen-detected aneurysm; 89 aneurysms were infrarenal, 20 juxtarenal and suprarenal, and 4 thoracoabdominal. The median aneurysm diameter at operation was 59 mm (interquartile range, 57-62 mm). Two open repairs and 111 endovascular repairs took place, using a variety of stent grafts. Three aneurysm-related deaths have occurred during follow-up, with two of these being in patients treated with stent grafts that have subsequently been removed from the market. There were 10 deaths from all causes. Twenty patients (17.7%) have required reintervention. There were 87 cases of elective infrarenal AAA repair; 86 were endovascular repairs. Of these patients, there were no aneurysm-related deaths or deaths within 30 days. Survival estimates were 100% at 1 year, 86.9% at 5 years, and 74.5% at 9 years of follow-up. Fourteen patients (16.1%) required reintervention. There were no secondary ruptures in patients treated electively for infrarenal aneurysms. This study shows that an endovascular first approach to the treatment of screen-detected AAA is a safe and effective one.