{"id":64,"date":"2025-10-01T01:27:59","date_gmt":"2025-10-01T01:27:59","guid":{"rendered":"https:\/\/cmcdeploytwo.co.nz\/vsoanz\/?page_id=64"},"modified":"2025-10-16T03:24:11","modified_gmt":"2025-10-16T03:24:11","slug":"aortic-aneurysm","status":"publish","type":"page","link":"https:\/\/cmcdeploytwo.co.nz\/vsoanz\/index.php\/aortic-aneurysm\/","title":{"rendered":"Aortic Aneurysm"},"content":{"rendered":"<div class=\"wpb-content-wrapper\">[vc_row full_width=&#8221;stretch_row&#8221; content_placement=&#8221;middle&#8221; equal_height=&#8221;yes&#8221; rtl_reverse=&#8221;yes&#8221; remove_bottom_col_margin=&#8221;true&#8221; columns_right=&#8221;yes&#8221; wpex_bg_color=&#8221;#03a3de&#8221; min_height=&#8221;350px&#8221;][vc_column width=&#8221;1\/2&#8243;]<style>.vcex-image.vcex_69d073b8ceb70 .vcex-image-img{object-position:right top;}<\/style><figure class=\"vcex-image vcex-module vcex-fill-column vcex_69d073b8ceb70\"><div class=\"vcex-image-inner wpex-relative wpex-w-100 vc_custom_1760585049321\"><img width=\"1210\" height=\"657\" src=\"https:\/\/cmcdeploytwo.co.nz\/vsoanz\/wp-content\/uploads\/2025\/10\/Abdominal-aortic-Aortic-Aneurysm-Abdominal-Screening_-copy.webp\" class=\"vcex-image-img wpex-align-middle wpex-w-100\" alt=\"\" loading=\"lazy\" decoding=\"async\" srcset=\"https:\/\/cmcdeploytwo.co.nz\/vsoanz\/wp-content\/uploads\/2025\/10\/Abdominal-aortic-Aortic-Aneurysm-Abdominal-Screening_-copy.webp 1210w, https:\/\/cmcdeploytwo.co.nz\/vsoanz\/wp-content\/uploads\/2025\/10\/Abdominal-aortic-Aortic-Aneurysm-Abdominal-Screening_-copy-300x163.webp 300w, https:\/\/cmcdeploytwo.co.nz\/vsoanz\/wp-content\/uploads\/2025\/10\/Abdominal-aortic-Aortic-Aneurysm-Abdominal-Screening_-copy-1024x556.webp 1024w, https:\/\/cmcdeploytwo.co.nz\/vsoanz\/wp-content\/uploads\/2025\/10\/Abdominal-aortic-Aortic-Aneurysm-Abdominal-Screening_-copy-768x417.webp 768w\" sizes=\"auto, (max-width: 1210px) 100vw, 1210px\" \/><\/div><\/figure>[\/vc_column][vc_column width=&#8221;1\/2&#8243;][vc_column_text css=&#8221;.vc_custom_1759281906916{padding-top: 20px !important;padding-bottom: 20px !important;}&#8221; color=&#8221;#fefefe&#8221;]\n<h1><strong>Aortic Aneurysm<\/strong><\/h1>\n[\/vc_column_text][\/vc_column][\/vc_row][vc_row css=&#8221;.vc_custom_1759015527111{margin-top: 60px !important;}&#8221;][vc_column][vc_tta_tour controls_size=&#8221;md&#8221; active_section=&#8221;1&#8243;][vc_tta_section title=&#8221;What is an abdominal aortic aneurysm?&#8221; tab_id=&#8221;1759012899351-dcaaabe1-cd5c883d-10e2&#8243;][vc_column_text css=&#8221;&#8221;]\n<h2 class=\"wp-block-heading\">What is an abdominal aortic aneurysm?<\/h2>\n<figure id=\"attachment_65\" aria-describedby=\"caption-attachment-65\" style=\"width: 217px\" class=\"wp-caption alignnone\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-65 size-full\" src=\"https:\/\/cmcdeploytwo.co.nz\/vsoanz\/wp-content\/uploads\/2025\/10\/AAAdiagram.jpg\" alt=\"Abdominal Aortic Aneurysm\" width=\"217\" height=\"240\" \/><figcaption id=\"caption-attachment-65\" class=\"wp-caption-text\">Abdominal Aortic Aneurysm<\/figcaption><\/figure>\n<p>&nbsp;<\/p>\n<p>An aneurysm is a swelling or dilatation in a blood vessel.\u00a0 Aneurysms can occur in any blood vessel, but are much more common in arteries, although they do occur rarely in veins.\u00a0 An abdominal aortic aneurysm (AAA) is a dilatation in the abdominal (tummy) part of a major artery \u2013 the aorta.\u00a0 This is one of the commonest types of aneurysm.[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;Are aortic aneurysms common?&#8221; tab_id=&#8221;1759012899354-da1d8fff-c098883d-10e2&#8243;][vc_column_text css=&#8221;&#8221;]\n<h2 class=\"wp-block-heading\">Are aortic aneurysms common?<\/h2>\n<p>Aortic aneurysms are fairly common especially in older men. \u00a0Hospital admission rates for aneurysms were increasing (<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16034842\" target=\"_blank\" rel=\"noreferrer noopener\">Filipovic M et al, 2005<\/a>) but recent studies indicate that the incidence of aneurysms may now be decreasing (<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21381003\" target=\"_blank\" rel=\"noreferrer noopener\">Sandiford et al, 2011<\/a>).\u00a0 About 6% of men (6 in 100) aged 80 years will have an aneurysm (<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/1348634\" target=\"_blank\" rel=\"noreferrer noopener\">Bengtsson H et al, 1992<\/a>). They account for 1.4% of deaths in men over the age of 65 years and 0.5% of deaths in women.\u00a0 About10,000 people die in the UK from a ruptured aortic aneurysm each year (<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2504226\/pdf\/annrcse01638-0025.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Sayers RD, 2002<\/a>).\u00a0 They are more common in brothers and there is an increased risk of an aortic aneurysm if you suffer from high blood pressure or\u00a0<a href=\"https:\/\/vascular-society.nz\/atherosclerosis\/\" target=\"_blank\" rel=\"noreferrer noopener\" data-type=\"page\" data-id=\"119\">atherosclerosis<\/a>\u00a0(hardening of the arteries) especially in smokers. Aortic aneurysms seem to be relatively rare in Asian populations.\u00a0 The Maori population in New Zealand has a higher death rate from aneurysms (8.9 per 100,000 in Maori vs 3.7 per 100,000 in non-Maori) and require more emergency operations than the non-Maori population, despite a slightly lower age-adjusted admission rate (12 per 100,000 vs 15 per 100,000,\u00a0<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/14598415\" target=\"_blank\" rel=\"noreferrer noopener\">Rosaak JI et al, 2003<\/a>).[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;Why do aortic aneurysms develop?&#8221; tab_id=&#8221;1759014772115-45b909ba-0338883d-10e2&#8243;][vc_column_text css=&#8221;&#8221;]\n<h2 class=\"wp-block-heading\">Why do aortic aneurysms develop?<\/h2>\n<p>We do not know exactly why some people develop aortic aneurysms.\u00a0 They are much more common in men and may sometimes run in the family.\u00a0 There seems to be an approximately four times increased risk of having an aneurysm for the brother of a patient with an aneurysm.\u00a0 Stated another way the brother of a patient with an aneurysm has about a 10-15% chance of developing an aneurysm.\u00a0 Most brothers (more than 80%) will not develop an aneurysm.\u00a0 Surprisingly, the presence of diabetes seems to have a slight protective effect on aneurysm development. Aneurysms may develop because of a weakness in the tissues holding the blood vessels together or possibly an imbalance in various enzymes (matrix metallo-proteinases or MMPs) that are found in the blood vessel wall.\u00a0 No specific genes have yet been identified in relation to aneurysms (<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/14515282\" target=\"_blank\" rel=\"noreferrer noopener\">Powell JT, 2003<\/a>). Inflammation has a role in the development of aneurysms and the latest work has indicated an important role for the protein Cyclophilin A which may trigger an inflammatory response (<a href=\"http:\/\/xa.yimg.com\/kq\/groups\/19704990\/187755678\/name\/Understanding%20Abdominal%20Aortic%20Aneurysm.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Wintraub 2009<\/a>).[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;Why are aortic aneurysms important?&#8221; tab_id=&#8221;1759014806183-f54d1997-de0b883d-10e2&#8243;][vc_column_text css=&#8221;&#8221;]\n<h2 class=\"wp-block-heading\">Why are aortic aneurysms important?<\/h2>\n<p>Aortic aneurysms are important because sometimes they can burst.\u00a0 When an aortic aneurysm bursts it is a catastrophic event in which the patient can die from internal bleeding in a matter of minutes.\u00a0 In most people a burst (ruptured) aortic aneurysm is fatal. The risk of an aneurysm rupturing varies with the aneurysm size.\u00a0 The larger the aortic aneurysm the more risk of it rupturing.\u00a0 Small\u00a0 aneurysms less than 5.5cms in diameter have an annual risk of rupture of less than 1% (1 in 100).\u00a0 This means that a patient, with an aortic aneurysm less than 5.5cms in diameter, has approximately a 1 in 100 chance of it bursting over the next 12 months. A recent Canadian study has reported specific figures for the risk of rupture based on aneurysm size (<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12563196.\" target=\"_blank\" rel=\"noreferrer noopener\">Brown PM et al 2003<\/a>).\u00a0 For men the annual risk of an aneurysm rupturing was 1-1.8% for aneurysms between 5.0 and 5.9cms, but increased to 14.1-15.6% when the aneurysm was 6cms or greater.\u00a0 In other words a man with a 5.4cms diameter aneurysm has only 1 or 2 chances in a hundred that his aneurysm will rupture in the next year.\u00a0 Once the aneurysm increases to 6.1cms that risk will increase to approximately 15 chances in a hundred.\u00a0 In women the risks are greater.\u00a0 A woman with an aneurysm between 5.0 and 5.9 cms has a 3.9 \u2013 4.7% risk of rupture over the next year.\u00a0 Once the aneurysm size increases beyond 6.0 cms the risk of rupture increases to 22 \u2013 30% over the next year.<\/p>\n<blockquote class=\"wp-block-quote is-layout-flow wp-block-quote-is-layout-flow\"><p>For individuals driving for domestic use: an individual with a thoracic aneurysm of greater than 6cm diameter or an abdominal aneurysm of greater than 5.5cm, or another vascular abnormality at risk of dissection or rupture, is generally considered unfit to drive. Individuals with Marfans syndrome should not drive if they have an aneurysm of greater than 4.5cm<\/p><\/blockquote>\n<p><strong>NZ Transport Agency regulations<\/strong><br \/>\nLess commonly aortic aneurysms can cause other symptoms. The aneurysm is usually lined by blood clot, which in most people, is not dangerous. Occasionally, parts of this blood clot can be dislodged and travel downwards to block arteries to the leg (embolism). As the aneurysm enlarges it can cause pressure on nerves and can occasionally lead to pressure on the ureter (the tube between the kidney and bladder). This can prevent urine draining from the kidneys normally and the kidneys can become damaged. Repair of an aortic aneurysm will stop these complications developing.[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;Can aortic aneurysms be prevented?&#8221; tab_id=&#8221;1759014827533-6ef99622-00a9883d-10e2&#8243;][vc_column_text css=&#8221;&#8221;]\n<h2 class=\"wp-block-heading\">Can aortic aneurysms be prevented?<\/h2>\n<p>At present aortic aneurysms cannot be prevented from developing, but their growth may be slowed by some simple measures.\u00a0 If you smoke, this increases the rate of growth of aortic aneurysms and you should stop immediately.\u00a0 Your blood pressure should be checked and if it is persistently raised you should have treatment to reduce your blood pressure.\u00a0 High blood pressure is a risk factor for aneurysm rupture.\u00a0 This does not mean your aortic aneurysm will rupture if you have high blood pressure, but it does place it at slightly higher risk of rupture. It is important to have your risk factors for hardening of the arteries monitored and treated if necessary as there is a clear increased risk of death even after the aneurysm has been treated due to cardiovascular disease (<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17514693\" target=\"_blank\" rel=\"noreferrer noopener\">UK Small aneurysm Trial Participants, 2012<\/a>). There is some evidence that cholesterol lowering drugs such as simvastatin, decrease the growth rate of aneurysms (<a href=\"http:\/\/ac.els-cdn.com\/S074152140800178X\/1-s2.0-S074152140800178X-main.pdf?_tid=8a7f7a00-86fc-11e2-bc93-00000aab0f01&amp;acdnat=1362643178_5c49b5b76645d3446240518c1ea6dfd2\" target=\"_blank\" rel=\"noreferrer noopener\">Schlosser et al 2008<\/a>).[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;How will I know if have an aortic aneurysm?&#8221; tab_id=&#8221;1759014855534-cd1bf395-e355883d-10e2&#8243;][vc_column_text css=&#8221;&#8221;]\n<h2 class=\"wp-block-heading\">How will I know if have an aortic aneurysm?<\/h2>\n<p>Unfortunately, many people will not know if they have an aortic aneurysm, because they rarely cause symptoms until they burst.\u00a0 Aortic aneurysms are sometimes found during a routine examination for other conditions such as prostate problems or gallstones.\u00a0 If you are a man over the age of 60 years, a smoker with high blood pressure and have a brother or father with an aortic aneurysm, then this puts you at increased risk.\u00a0If you also have hardening of the arteries at other sites (eg previous stroke or heart attack) then you may also be at increased risk. Occasionally patients present with embolism of blood clot in the aneurysm sac to the lower limb arteries. This occurs when clot is dislodged and travels down to the arteries to the legs and interferes with the blood supply causing scattered areas of mottling in the feet and sometimes gangrene. Although examination by your doctor may be helpful in diagnosing a large aortic aneurysm, it is not a sensitive method of diagnosing smaller aneurysms.\u00a0 The best way to diagnose an aneurysm is with an ultrasound scan of the abdomen.\u00a0 This is a very quick, simple, accurate and safe test that is also commonly used to examine babies in the womb. Occasionally, patients experience abdominal and back pain and the aneurysm becomes tender before it ruptures.\u00a0 If this happens and you know you have an aneurysm, then it is important to seek emergency medical advice. Before surgery most patients will undergo CT (computed tomography) scanning to show the aneurysm in more detail.\u00a0 The picture below is a CT scan of an aneurysm.\u00a0 This picture represents a slice across the abdomen.\u00a0 The spinal column and back is shown in the lower portion of the picture.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-70 alignnone\" src=\"https:\/\/cmcdeploytwo.co.nz\/vsoanz\/wp-content\/uploads\/2025\/10\/AAACTscanrev.gif\" alt=\"\" width=\"240\" height=\"176\" \/><\/p>\n<p>White arrow points to aneurysm<\/p>\n<p>T is thrombus or blood clot inside the enlarged artery<\/p>\n<p>L is the lumen or part of the artery where blood is flowing.<\/p>\n<p>IVC is inferior vena cava or the main vein in the abdomen.<\/p>\n[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;When do aortic aneurysms require treatment?&#8221; tab_id=&#8221;1759014887716-648cb14b-0019883d-10e2&#8243;][vc_column_text css=&#8221;&#8221;]\n<h2 class=\"wp-block-heading\">When do aortic aneurysms require treatment?<\/h2>\n<p>In healthy people the aorta (the main blood vessel that becomes swollen) is usually about 2.0-2.5 cms (20-25mm) in diameter although this can vary with age and whether you are a man or a woman.\u00a0 We know from two large studies in the USA and UK (<a href=\"http:\/\/www.nejm.org\/doi\/pdf\/10.1056\/NEJMoa012573\" target=\"_blank\" rel=\"noreferrer noopener\">Lederle FA et al, 2002<\/a>) that aneurysms less than 5.5 cms (55mm) across can be safely watched as long as they are monitored on a regular basis.\u00a0 For aneurysms less than 4.4 cms across or less, a yearly ultrasound scan is sufficient to monitor aneurysm growth.\u00a0 For aneurysms between 4.5 and 4.9 cms across, a scan every 6 months is advised.\u00a0 An aneurysm greater than 5.0 cms across requires scans every 3 months although there is some variation in recommendations.<\/p>\n<p>When an aneurysm reaches 5.5 cms most surgeons would consider offering surgical intervention.\u00a0 This is because, at this size, the aneurysm has a greater risk of rupture.\u00a0 It then becomes as safe to have an operation to repair the aneurysm, as it is to leave the aneurysm alone.\u00a0 Surgery may also be considered if your aneurysm is rapidly expanding on regular scans or it starts to cause other complications (see above).\u00a0 Rapid expansion means more than 7mm in 6 months or 10mm in one year.<\/p>\n<p>Whether you proceed with surgery will not just depend on the size of the aneurysm.\u00a0 It is important that each patient is fit enough to withstand the operation.\u00a0 Fitness for surgery can be affected by many factors and the decision whether or not to proceed with surgery can be a difficult one, as it is a very major operation.\u00a0 It will only be after a detailed discussion with your surgeon, regarding your own personal circumstances\u00a0 and type of treatment available, that a decision can be reached.<\/p>\n<p>There is still some debate on the treatment of aneurysms between 4.0 and 5.5cms despite the large UK and North American trials indicating that there is no clear benefit. Looked at in another way though, there was no clear disadvantage to having the aneurysm treated at an earlier stage. Overall 60% of all patients in the trial would eventually require an operation so why not step in at an earlier stage? Taking patients with aneurysms over 5.0cms the argument is even more convincing, as over 80% of these patients eventually require surgery. However, the accepted size to initiate treatment is still 5.5cms (55mm).<\/p>\n<p>Endovascular treatment of aneurysms (see below) has lower operative mortality than open surgery and it was proposed that treating smaller aneurysms with endovascular stents would lead to better outcomes, but in fact the\u00a0<a href=\"http:\/\/education.surgery.ufl.edu\/Lectures\/CAESAR.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">CAESAR<\/a>\u00a0and\u00a0<a href=\"http:\/\/zarinslab.stanford.edu\/publications\/zarins_bib\/zarins_pdf\/2010\/ouriel_repair_jvs10.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">PIVOTAL<\/a>\u00a0trials have not shown any advantage for treating smaller AAAs with EVAR. An interesting extra finding was that some of the smaller aneurysms (about 1 in 6) may become unsuitable for EVAR as they grow towards the usual size for intervention, although there is some disagreement on this point. If your aneurysm bursts it usually causes severe back and abdominal pain.\u00a0 The bleeding can stop temporarily in some patients and in these patients an emergency operation can be successful at repairing the aneurysm. The majority of patients (70-80%) with a ruptured abdominal aneurysm will not survive.\u00a0 It is important to remember that although any anxiety you may have had about your aortic aneurysm will be relieved by having it repaired, the operation will not make you feel physically better.\u00a0 This is because most patients do not have symptoms from their aneurysm before the operation.\u00a0 The operation is a treatment to prevent the aneurysm rupturing or causing other complications in the future.[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;Thoracoabdominal aneurysms&#8221; tab_id=&#8221;1759282638504-6378f8b1-64fe&#8221;][vc_column_text css=&#8221;&#8221;]\n<h2 class=\"wp-block-heading\">Thoracoabdominal aneurysms<\/h2>\n<p>Most (90%) aortic aneurysms are found below the arteries to the kidneys (renal arteries) in the abdomen Some aneurysms can extend upwards to involve the arteries to the kidneys, the arteries to the intestines, liver and stomach. More extensive aneurysms will involve the aorta from where it leaves the heart and can extend throughout the chest.\u00a0Thoracic (in the chest) aneurysms are probably under-recognised and may involve single or multiple segments of the aorta in the chest. There are rare genetic conditions which can predispose to thoracic aneurysms such as\u00a0<a href=\"http:\/\/en.wikipedia.org\/wiki\/Ehlers%E2%80%93Danlos_syndrome\" target=\"_blank\" rel=\"noreferrer noopener\">Ehlers-Danlos syndrome<\/a>\u00a0and\u00a0<a href=\"http:\/\/en.wikipedia.org\/wiki\/Marfan_syndrome\" target=\"_blank\" rel=\"noreferrer noopener\">Marfan syndrome<\/a>. Aneurysms above 6cm carry a significant increased risk of rupture (<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22840907\" target=\"_blank\" rel=\"noreferrer noopener\">Kuzmick et al 2012<\/a>). Thoracic aneurysms are much more difficult to repair and carry much greater risks from treatment.\u00a0 Open surgery for these aneurysms is massive surgery, but until recently was the only treatment available. Newer endovascular treatments are revolutionising therapy in patients with these aneurysms and extending the treatment to patients who previously would have been considered unfit for open repair. Detailed anatomical information is required not only about the aneurysm but also about the aortic branches and their relationship to one another in 3-D. This is a rapidly developing area with different devices and different combinations of treatments being explored.[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;What treatments are available for aortic aneurysms?&#8221; tab_id=&#8221;1759282671952-628b4e26-bea3&#8243;][vc_column_text css=&#8221;&#8221;]\n<h2 class=\"wp-block-heading\">What treatments are available for aortic aneurysms?<\/h2>\n<p><strong>Open Surgery<\/strong>\u00a0\u2013 the traditional treatment for aneurysms is surgery to replace the diseased blood vessel with an artificial blood vessel (graft).\u00a0 In the conventional open operation a large incision is made in the abdomen.\u00a0 The blood vessels above and below the aneurysm are clamped in order to control any bleeding and the aneurysm itself is opened.\u00a0 Any blood clot in the aneurysm is removed and any bleeding blood vessels are controlled.\u00a0 The artificial graft is then stitched into place using permanent stitches (see picture right).\u00a0 The graft is made from a man-made material called\u00a0<a href=\"http:\/\/en.wikipedia.org\/wiki\/Polyethylene_terephthalate\" target=\"_blank\" rel=\"noreferrer noopener\">Dacron<\/a>, similar to Terylene.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-71 alignnone\" src=\"https:\/\/cmcdeploytwo.co.nz\/vsoanz\/wp-content\/uploads\/2025\/10\/AAAopdiagram.tiff-copy.jpg\" alt=\"\" width=\"200\" height=\"328\" srcset=\"https:\/\/cmcdeploytwo.co.nz\/vsoanz\/wp-content\/uploads\/2025\/10\/AAAopdiagram.tiff-copy.jpg 200w, https:\/\/cmcdeploytwo.co.nz\/vsoanz\/wp-content\/uploads\/2025\/10\/AAAopdiagram.tiff-copy-183x300.jpg 183w\" sizes=\"auto, (max-width: 200px) 100vw, 200px\" \/><\/p>\n<p>This is a major operation requiring 7-10 days in hospital and usually a short post-operative stay on the intensive care unit.\u00a0 If you have this operation as a planned procedure there is an overall risk of dying of around 5%.\u00a0 This means that 95 patients out of every 100 will be fine and come through the operation.\u00a0 However, a small number of patients (approximately 5 in 100) will die in hospital either during or more commonly after their operation. These are average results when looked at overall on a country wide basis, although some individual units may claim better survival figures.\u00a0 It is important to remember that your chances of surviving a planned operation are much better than if your aneurysm ruptures, when the overall chance of dying is around 80%.\u00a0 This means that 80 patients out of every 100 who have a ruptured aneurysm will die. The conventional open operation has a history dating back over 55 years and is a very effective and durable treatment for aneurysms.\u00a0 Once patients have recovered from the operation most do not have further problems.<\/p>\n<p><strong>Endovascular stenting<\/strong>\u00a0\u2013 over the last 18 years a new treatment has become available (Endovascular Aneurysm Repair or EVAR).\u00a0 This procedure is different from the conventional operation because it does not usually require any cuts in the tummy.\u00a0 Two small vertical cuts are made in the groin and an artificial graft (tailored individually for each aortic aneurysm) is delivered to and deployed from inside the aneurysm itself.\u00a0 This operation requires a special delivery device to deliver the graft through the arteries to the aneurysm.\u00a0 At least 16 different delivery devices have been developed to facilitate this procedure and it is likely that major advances in delivery systems and devices will continue to simplify the operation.<\/p>\n<p>The video opposite shows a simulation of endovascular stent placement. EVAR is a rapidly developing field with robotic enhancements on the horizon. The stenting operation is only suitable for patients with certain shapes (morphology) of aortic aneurysm.\u00a0 The number of patients suitable for EVAR varies to some extent on the expertise of the local unit.\u00a0 Only about 50-60% of aneurysms will be suitable for the endovascular technique, but it has the attraction of being much less traumatic than the open procedure.\u00a0 As modern generation devices are refined, more and more aneurysms are becoming suitable for the endovascular technique. Recovery is faster for most people and it may permit much earlier discharge from hospital.\u00a0 More and more complex graft stents are being developed which will deal not only with abdominal aneurysms but also with complex aortic arch and thoacoabdominal aneurysms involving major branches of the aorta. An endovascular graft can be constructed with branches to supply major arterial vessels (branched graft) or holes (fenestrations) can be created in the side of the graft so a stent can be inserted into the branch (fenestrated graft).\u00a0Hybrid procedures involve a combination of open and endovascular techniques. These techniques are expanding the population suitable for aneurysm treatment as previously only relatively fit patients could withstand the major surgery involved in repair of complex thoracoabdominal aneurysms.<\/p>\n<p><strong>Laparoscopic aneurysm repair<\/strong>\u00a0\u2013 There are a few centres developing keyhole surgery for aortic aneurysm repair.\u00a0 In principle this operation is the same as open surgery (see above).\u00a0 The aneurysm is approached from the outside and a graft stitched into place.\u00a0 It is different from the open operation because the incisions used in the abdomen are much smaller.<\/p>\n<p>It is not available as an option in most departments and only a few expert laparoscopic surgeons around the world are performing this procedure and it may turn out to be a surgical dead end.\u00a0 It will require considerable development if it is to become routine, but has the attraction of implanting the graft in a traditional way but without a large incision.\u00a0 This would combine the advantages of a minimally invasive and low trauma approach, with the durability and long term freedom from complications of an open repair.<\/p>\n<p><strong>Non-surgical treatments<\/strong>\u00a0\u2013 the ultimate aim of some research is to slow or prevent aneurysm growth, reducing or eliminating the need for surgery.\u00a0 There are no treatments proven to reduce the need for aneurysm surgery but work continues. Beta blockers, such as metoprolol or atenolol, may be helpful. A recent study (<a href=\"http:\/\/www.vhpharmsci.com\/decisionmaking\/Therapeutic_Decision_Making\/Intermediate_files\/ACE%20inhibitors%20and%20aortic%20rupture-%20a%20population-based%20case-control%20study-Lancet.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Hackam DG et al, 2006<\/a>) has reported that the use of angiotensin converting enzyme inhibitor drugs (captopril for example) was associated with a reduced risk of aneurysm rupture, but further studies are required.<strong>Emergency treatment for ruptured aneurysms \u2013\u00a0<\/strong>patients who do not die from a ruptured aneurysm in the community may present to hospital as an emergency usually with back and abdominal pain. For most of these patients emergency open surgery is still by far the commonest procedure. There is about a 50-60% chance of surviving the operation but recovery in these circumstances is often prolonged. There are some tertiary centres that are performing endovascular repair for ruptured aneurysms with good results but this requires well manned units with top class radiological\/operating facilities and considerable experience of endovascular repair.[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;What are the results of surgery for aortic aneurysms?&#8221; tab_id=&#8221;1759282804475-c5e14ca0-122e&#8221;][vc_column_text css=&#8221;&#8221;]\n<h2 class=\"wp-block-heading\">What are the results of surgery for aortic aneurysms?<\/h2>\n<p>There are two major studies (the Dutch Randomised Endovascular Aneurysm Management (DREAM) trial and the Endovascular Aneurysm Repair Trial-1 (EVAR-1)) that have reported on the endovascular treatment of infrarenal abdominal aortic aneurysms (the commonest aneurysms). These trials have rigorous trial designs and protocols that have demonstrated significant improvements in 30 day mortality in patients undergoing endovascular repair (<a href=\"http:\/\/www.nejm.org\/doi\/pdf\/10.1056\/NEJMoa042002\" target=\"_blank\" rel=\"noreferrer noopener\">Prinsen M et al, 2004<\/a>;\u00a0<a href=\"http:\/\/www.aneurismas.com.br\/adm\/fotos\/060b0cb8a67bf4ccfc95c7c31021511c.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Greenhalgh RM et al, 2004<\/a>) when compared with traditional open repair for abdominal aortic aneurysms.<\/p>\n<p>In the DREAM trial the risk of dying from open surgery was reduced from 4.6% to 1.2% with endovascular stenting at 30 days after operation.\u00a0 EVAR-1 showed a similar reduction in 30 day operative mortality from 4.7% with open repair to 1.7% with endovascular repair.\u00a0 By 1 year after surgery this benefit had disappeared in the DREAM trial patients (<a href=\"http:\/\/www.nejm.org\/doi\/pdf\/10.1056\/NEJMoa051255\" target=\"_blank\" rel=\"noreferrer noopener\">Blankensteijn JD et al, 2005<\/a>).\u00a0 At two years the survival rates were 89.6% in the open surgery patients and 89.7% in the endovascular repair group.\u00a0 The initial advantage of having an endovascular repair only seemed to last for a short period (months) around the time of the operation and was then lost. Follow up data (<a href=\"http:\/\/www.nejm.org\/doi\/pdf\/10.1056\/NEJMoa0909305\" target=\"_blank\" rel=\"noreferrer noopener\">EVAR Trial Investigators 2010<\/a>,\u00a0<a href=\"http:\/\/www.nejm.org\/doi\/pdf\/10.1056\/NEJMoa0909499\" target=\"_blank\" rel=\"noreferrer noopener\">De Bruin JL et al 2010<\/a>,\u00a0<a href=\"http:\/\/academicdepartments.musc.edu\/surgery\/education\/journal_club\/08-09\/october1.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">EVAR Trial Participants 2005<\/a>) have confirmed that the initial survival advantage for endovascular repair is not maintained and longer term survival is just as likely with open surgical repair.\u00a0 It may be that open repair precipitates death in some of the more fragile patients who may only have a limited life expectancy because of other serious illnesses.\u00a0There is also some evidence that kidney function may deteriorate more quickly after EVAR.<\/p>\n<p>EVAR-2 (<a href=\"http:\/\/www.nejm.org\/doi\/pdf\/10.1056\/NEJMoa0911056\" target=\"_blank\" rel=\"noreferrer noopener\">EVAR Trial Participants, 2010<\/a>\u00a0and\u00a0<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15978926\" target=\"_blank\" rel=\"noreferrer noopener\">2005<\/a>) was a UK study which compared best medical treatment for patients with aortic aneurysms against endovascular repair. This study looked at patients who were not fit for open surgery.\u00a0 After 6-8 years of follow up the overall mortality rates were high at 73% (145 of 197) of patients who underwent endovascular repair and 77% for patients treated medically.\u00a0 This was not a statistically different result and the authors conclude that there is no benefit in having aneurysm treatment, even with the less traumatic endovascular technique if patients have other significant illnesses that preclude open repair. The difficulty here is defining what constitutes significant illness and this will definitely vary between different surgeons. For patients at higher risk careful thought on each individual\u2019s risk\/benefit from treatment will be helpful.<\/p>\n<p>Despite the benefits clearly demonstrated on early mortality with endovascular repair, there are still two major unresolved issues.\u00a0 They are the durability of the procedure and the problem of endoleak (see below in complications).<\/p>\n<p>The long term durability of endovascular stenting is becoming clearer but there are still unknowns as the technology and indications for intervention change and it is not a risk free alternative to open surgery (<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15227687\" target=\"_blank\" rel=\"noreferrer noopener\">Gorham TJ et al, 2004<\/a>).\u00a0 A review article in the Journal of Vascular Surgery (<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15111875\" target=\"_blank\" rel=\"noreferrer noopener\">Rutherford RB and Krupski WC, 2004<\/a>) concluded that in our present state of knowledge traditional open surgical repair is still to be preferred in younger patients at low operative risk \u2013 a view endorsed again in 2005 (<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15978908\" target=\"_blank\" rel=\"noreferrer noopener\">Cronenwett JL, 2005)<\/a>. Increasingly this view is being challenged and in most current practice if a patient has an aneurysm suitable for endovascular repair then this treatment will be offered.<\/p>\n<p>Endovascular stenting is here to stay and in fact is the treatment of choice for 50-60% of all patients with aneurysms in the USA (<a href=\"http:\/\/ac.els-cdn.com\/S0741521405019087\/1-s2.0-S0741521405019087-main.pdf?_tid=cc51a0e2-86fd-11e2-9515-00000aab0f6b&amp;acdnat=1362643718_32fdca115bd300636cf1aa4cd0ba0c07\" target=\"_blank\" rel=\"noreferrer noopener\">Nowygrod, 2006<\/a>). Technology will continue to evolve and complication rates are likely to improve further and there is reasonable evidence that they are dropping already.<\/p>\n<p>At present patients who have undergone EVAR require lifelong follow up with imaging of their graft to detect problems at an early stage.\u00a0 This is usually by a combination of CT scan and ultrasound with angiography reserved for treating problems when they occur. Ultrasound is becoming the standard investigation and contrast enhanced ultrasound using second generation contrast agents holds promise but more research is required on accuracy and optimal follow up regimes. One study has suggested that follow up may be targeted as most complications occur in patients who develop symptoms (<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20235086\" target=\"_blank\" rel=\"noreferrer noopener\">Karthikesalingam A et al<\/a>).[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;Are there complications of treatment?&#8221; tab_id=&#8221;1759282874670-a90bd8d3-8599&#8243;][vc_column_text css=&#8221;&#8221;]\n<h2 class=\"wp-block-heading\">Are there complications of treatment?<\/h2>\n<p>There are a number of potential problems that can occur after open aortic aneurysm surgery.\u00a0 These fall into 2 main categories: generalised complications and local complications.\u00a0 Both types of complication can prolong the stay in hospital and may be fatal if they are severe enough.\u00a0 There is a risk of dying from open aneurysm surgery of between 3-5%.<\/p>\n<p><strong>Generalised complications<\/strong>\u00a0\u2013 this means problems that can occur away from the site of the operation.\u00a0 They occur because a major operation under general anaesthesia has been performed usually with significant blood loss.\u00a0 The commonest types of generalised complication usually occur in the heart or the lungs. They take the form of angina (chest pain), heart attacks and chest infections.\u00a0 In the majority of patients, especially those having a planned operation, these complications can be successfully treated. The combined presence of heart lung and kidney complications can result in the condition of multi-organ failure (MOF).\u00a0 This is frequently fatal.\u00a0 Another generalised complication that can occur with any operation is Deep Venous Thrombosis (DVT)<\/p>\n<p><strong>Local complications<\/strong>\u00a0\u2013 this means problems related to the site of the operation.\u00a0 The main early problem that can occur is bleeding at the place where the main artery has been joined to the artificial graft.\u00a0 This can be severe.\u00a0 The surgeon will stop all bleeding before completing your operation but sometimes further bleeding can develop during the recovery period \u2013 especially within the first 24 hours.\u00a0 If this happens the patient can require a further operation to control the bleeding.<\/p>\n<p>Nerves controlling sexual function run very close to the aorta.\u00a0 Although attempts to preserve these nerves are usually made during an aneurysm repair they can be frequently damaged.\u00a0 In men this can lead to loss of erections.\u00a0 If erections are preserved, retrograde ejaculation can take place where the semen is ejected into the bladder due to incoordination of the various muscles.\u00a0 The effects of damage to the same nerves in women are not clear in the age group that usually require this operation.<\/p>\n<p>Sometime after the operation, infection can develop in the artificial graft, although this is rare.\u00a0 If this does occur it can be a major problem and will probably lead to further surgery to fix the problem. Occasionally replacement of the major artery in the abdomen can lead to impairment of the blood supply to part of the colon (colonic ischaemic).\u00a0 If this becomes very severe then further surgery can be necessary to remove the damaged colon and prevent further complications.<\/p>\n<p>In approximately 30% of patients a weakness can develop in the scar on the tummy.\u00a0If this happens it occurs months or even years after recovery from the original surgery.\u00a0 It can lead to bulging in the abdominal wound and the development of an incisional hernia.\u00a0 This seems to be more common in aneurysm patients and may require a further operation. Endoleak is a complication virtually exclusive to endovascular aneurysm repair.\u00a0 The behaviour and management of different types of endoleak is becoming more clear cut with increased experience in this area.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-72 alignnone\" src=\"https:\/\/cmcdeploytwo.co.nz\/vsoanz\/wp-content\/uploads\/2025\/10\/endoleaks-detail.jpg\" alt=\"\" width=\"473\" height=\"479\" srcset=\"https:\/\/cmcdeploytwo.co.nz\/vsoanz\/wp-content\/uploads\/2025\/10\/endoleaks-detail.jpg 473w, https:\/\/cmcdeploytwo.co.nz\/vsoanz\/wp-content\/uploads\/2025\/10\/endoleaks-detail-296x300.jpg 296w\" sizes=\"auto, (max-width: 473px) 100vw, 473px\" \/><\/p>\n<p>Not all endoleaks demand immediate correction. Endoleak is only a problem in patients undergoing endovascular repair.\u00a0 It occurs when the seal between the graft and the normal arterial wall or between two segments of graft is incomplete (see diagram below (Type I \u2013 V endoleaks).\u00a0 If the seal is not complete blood can leak through the seal and fill the aneurysm as it did before the operation.\u00a0 There are also other types of endoleak in which small arterial branches of the aneurysm continue to fill the aneurysm sac.\u00a0 If endoleaks are significant and cause pressurisation of the partly excluded sac (endotension) this can lead to aneurysm rupture \u2013 the very thing surgeons are trying to prevent.\u00a0The EVAR and DREAM trials were initiated many years ago and complication rates may not reflect current practice. There are also varying estimates of the risk of reintervention, but the most reliable results will be from the trials. EVAR-1 showed the risk of complications developing over 6-8 years was 45% (282 of 626) in the endovascular group versus 13% (78 of 626) in the open repair group.\u00a0 Around 20-30% of patients (20-30 in every 100 patients) will require a further procedure over 6-8 years to keep the stent working normally and prevent aneurysm rupture. After open surgery the risk of reintervention over the same time period is about 8-10%. A recent\u00a0<a href=\"http:\/\/www.nejm.org\/doi\/pdf\/10.1056\/NEJMe048258\" target=\"_blank\" rel=\"noreferrer noopener\">editorial<\/a>\u00a0has drawn attention to the 3% ongoing annual failure rate for endovascular grafts.\u00a0 This is in addition to the annual rate of further intervention in conjunction with a need for lifelong follow-up.\u00a0 The author also highlights results from the Cleveland Clinic (a well known US vascular centre) where the results of endovascular grafting in large aneurysms were concerning with a 10% (1 in 10) 4 year risk of rupture for aneurysms 6.5cm in diameter or greater at the time of endovascular repair. In other words, even after apparently successful endovascular repair patients with large aneurysms still had a 1 in 10 chance of their aneurysm rupturing.[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;What measures are taken to reduce complications?&#8221; tab_id=&#8221;1759283044636-ac9f1318-f32e&#8221;][vc_column_text css=&#8221;&#8221;]\n<h2 class=\"wp-block-heading\">What measures are taken to reduce complications?<\/h2>\n<p><strong>To reduce the risk of DVT<\/strong>\u00a0\u2013 Anti-embolic graduated compression stockings may be used, providing there is no evidence of hardening of the arteries in the legs.\u00a0 Intermittent compression of the legs and\/or feet using airbags is sometimes used in theatre to improve blood flow in the leg veins during the anaesthetic.\u00a0 Most patients also receive heparin injections to reduce the risk of blood clots forming.\u00a0 After your operation you will be encouraged to move around as early as possible.<strong>To reduce the risk of infection<\/strong>\u00a0\u2013 Antibiotics will be given at the start of the operation and sometimes for one or two doses after the operation.\u00a0 Physiotherapy will be started shortly after the operation to prevent secretions accumulating in the chest.[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;Aortic aneurysm screening programmes&#8221; tab_id=&#8221;1759283041609-813b2712-e575&#8243;][vc_column_text css=&#8221;&#8221;]\n<h2 class=\"wp-block-heading\">Aortic aneurysm screening programmes<\/h2>\n<p>As aneurysms can be a serious health issue much effort has been directed at trying to identify aneurysms before they rupture.\u00a0 Screening programmes have been used to detect patients with aortic aneurysms and to monitor the aneurysms if they are small.\u00a0 An aortic aneurysm will usually develop slowly and enlarge over a period of years.\u00a0 Surgery can be considered as the aneurysm enlarges.\u00a0 Although these\u00a0<a href=\"https:\/\/vascular-society.nz\/abdominal-aortic-aneurysm-screening\/\" target=\"_blank\" rel=\"noreferrer noopener\" data-type=\"page\" data-id=\"103\">AAA screening<\/a>\u00a0programmes cannot prevent aortic aneurysms forming, they are able to reduce the chances of an aneurysm rupturing by treating it at an early stage.[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;Aortic aneurysm links&#8221; tab_id=&#8221;1759014929506-4e94bf49-783d883d-10e2&#8243;][vc_column_text css=&#8221;&#8221;]\n<h2 class=\"wp-block-heading\">Aortic aneurysm links<\/h2>\n<p><strong>General<\/strong><\/p>\n<p><a href=\"http:\/\/www.nhs.uk\/conditions\/repairofabdominalaneurysm\/pages\/introduction.aspx\">http:\/\/www.nhs.uk\/conditions\/repairofabdominalaneurysm\/pages\/introduction.aspx<\/a><\/p>\n<p><a href=\"http:\/\/hcd2.bupa.co.uk\/fact_sheets\/Mosby_factsheets\/aortic_aneurysm.html\">http:\/\/hcd2.bupa.co.uk\/fact_sheets\/Mosby_factsheets\/aortic_aneurysm.html<\/a><\/p>\n<p><a href=\"http:\/\/www.medicinenet.com\/abdominal_aortic_aneurysm\/article.htm\">http:\/\/www.medicinenet.com\/abdominal_aortic_aneurysm\/article.htm<\/a><\/p>\n<p><a href=\"http:\/\/www.emedicine.com\/med\/topic3443.htm\">http:\/\/www.emedicine.com\/med\/topic3443.htm<\/a><\/p>\n<p><a href=\"http:\/\/www.surgical-tutor.org.uk\/default-home.htm?system\/vascular\/aaa.htm~right\">http:\/\/www.surgical-tutor.org.uk\/default-home.htm?system\/vascular\/aaa.htm~right<\/a><\/p>\n<p><a href=\"http:\/\/en.wikipedia.org\/wiki\/Abdominal_aortic_aneurysm\">http:\/\/en.wikipedia.org\/wiki\/Abdominal_aortic_aneurysm<\/a><\/p>\n<p><a href=\"http:\/\/en.wikipedia.org\/wiki\/Aortic_aneurysm\">http:\/\/en.wikipedia.org\/wiki\/Aortic_aneurysm<\/a><\/p>\n<p><a href=\"http:\/\/www.uptodate.com\/patients\/content\/topic.do?topicKey=hrt_dis\/4453&amp;title=Abdominal+aortic+aneurysm\">http:\/\/www.uptodate.com\/patients\/content\/topic.do?topicKey=hrt_dis\/4453&amp;title=Abdominal+aortic+aneurysm<\/a><\/p>\n<p><strong>Images<\/strong><\/p>\n<p><a href=\"http:\/\/www.gvg.org.uk\/pics.htm\">http:\/\/www.gvg.org.uk\/pics.htm<\/a><\/p>\n<p><a href=\"http:\/\/www.vesalius.com\/graphics\/archive\/archtn.asp?VID=664&amp;nrVID=663\">http:\/\/www.vesalius.com\/graphics\/archive\/archtn.asp?VID=664&amp;nrVID=663<\/a><\/p>\n<p><a href=\"http:\/\/www.vesalius.com\/graphics\/archive\/archtn.asp?VID=631&amp;nrVID=630\">http:\/\/www.vesalius.com\/graphics\/archive\/archtn.asp?VID=631&amp;nrVID=630<\/a><\/p>\n<p><strong>Endovascular Stenting<\/strong><\/p>\n<p><a href=\"http:\/\/www.uva.vasculardomain.com\/images\/uploaded\/uva\/stents.cfm\">http:\/\/www.uva.vasculardomain.com\/images\/uploaded\/uva\/stents.cfm<\/a><\/p>\n<p><a href=\"http:\/\/www.dcmsonline.org\/jax-medicine\/2000journals\/dec2000\/endovascular.htm\">http:\/\/www.dcmsonline.org\/jax-medicine\/2000journals\/dec2000\/endovascular.htm<\/a><\/p>\n<p><a href=\"http:\/\/www.sirweb.org\/patPub\/abdominalAorticAneurysms.shtml\">http:\/\/www.sirweb.org\/patPub\/abdominalAorticAneurysms.shtml<\/a><\/p>\n<p><a href=\"http:\/\/www.pennhealth.com\/int_rad\/health_info\/aaa.html\">http:\/\/www.pennhealth.com\/int_rad\/health_info\/aaa.html<\/a><\/p>\n<p><a href=\"http:\/\/www.orlive.com\/baptisthealth\/videos\/aortic-aneurysm-repair?view=displayPageNLM\">http:\/\/www.orlive.com\/baptisthealth\/videos\/aortic-aneurysm-repair?view=displayPageNLM<\/a><\/p>\n[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;References&#8221; tab_id=&#8221;1759015003224-6e58c0d1-e0df883d-10e2&#8243;][vc_column_text css=&#8221;&#8221;]\n<h2>References<\/h2>\n<p><a style=\"letter-spacing: 0px;\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/1348634\" target=\"_blank\" rel=\"noreferrer noopener\">Bengtsson H, Bergqvist D, Sternby NH. Increasing prevalence of abdominal aortic aneurysms. A necropsy study.<\/a><span style=\"letter-spacing: 0px;\">\u00a0Eur J Surg 1992; 158: 19-23.<\/span><\/p>\n<div id=\"primary\" class=\"content-area\">\n<p>&nbsp;<\/p>\n<article id=\"post-43\" class=\"post-43 page type-page status-publish hentry\">\n<div class=\"entry-content\">\n<p><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2504226\/pdf\/annrcse01638-0025.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Sayers RD.\u00a0 Aortic aneurysms, inflammatory pathways and nitric oxide.<\/a>\u00a0Ann Roy Coll Surg Eng 2002; 84: 239-246.<br \/>\n<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/14598415\" target=\"_blank\" rel=\"noreferrer noopener\">Rossak JI, Sporle A, Birks CL, van Rij AM. Abdominal aortic aneurysms in the New Zealand Maori population.<\/a>\u00a0Brit J Surg 2003; 90: 1361-1366.<br \/>\n<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16034842\" target=\"_blank\" rel=\"noreferrer noopener\">Filipovic M, Goldacre MJ, Roberts SE et al. Trends in mortality and hospital admission rates for abdominal aortic aneurysm in England and Wales, 1979-1999.<\/a>\u00a0Brit J Surg 2005; 92: 968-975.<br \/>\n<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21381003\" target=\"_blank\" rel=\"noreferrer noopener\">Sandiford P, Mosquera D, Bramley D. Trends in incidence and mortality from abdominal aortic aneurysm in New Zealand.<\/a>\u00a0Brit J Surg 2011; 98: 645-651.<br \/>\n<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/14515282\" target=\"_blank\" rel=\"noreferrer noopener\">Powell JT. Familial clustering of abdominal aortic aneurysm \u2013 smoke signals, but no culprit genes.\u00a0<\/a>Brit J Surg 2003; 90: 1173-74.<br \/>\n<a href=\"http:\/\/xa.yimg.com\/kq\/groups\/19704990\/187755678\/name\/Understanding%20Abdominal%20Aortic%20Aneurysm.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Weintraub NL Understanding abdominal aortic aneurysms\u00a0<\/a>N Engl J Med 2009; 361: 1114-1116.<br \/>\n<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12563196\" target=\"_blank\" rel=\"noreferrer noopener\">Brown PM, Zelt DT, Sobolev B.\u00a0 The risk of rupture in untreated aneurysms: the impact of size, gender and expansion rate.\u00a0<\/a>J Vasc Surg 2003; 37: 280-284.<br \/>\n<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17514693\" target=\"_blank\" rel=\"noreferrer noopener\">UK Small Aneurysm Trial Participants.\u00a0 Final 12-year follow-up of surgery versus surveillance in the UK small aneurysm trial.<\/a>\u00a0Brit J Surg; 94: 702-708.<br \/>\n<a href=\"http:\/\/ac.els-cdn.com\/S074152140800178X\/1-s2.0-S074152140800178X-main.pdf?_tid=81f6c202-854f-11e2-803f-00000aacb360&amp;acdnat=1362458910_3fe19dff253b1806afcf4e885b1c5f1f\" target=\"_blank\" rel=\"noreferrer noopener\">Schlosser FJV, Tangelder MJD, Verhagen HJM et al. Growth predictors and prognosis of small abdominal aortic aneurysms.\u00a0<\/a>J Vasc Surg 2008; 47: 1127-33.<br \/>\n<a href=\"http:\/\/www.nejm.org\/doi\/pdf\/10.1056\/NEJMoa012573\" target=\"_blank\" rel=\"noreferrer noopener\">Lederle FA et al. Immediate repair compared with surveillance of small abdominal aortic aneurysms.<\/a>\u00a0N Engl J Med 2002; 346: 1437-44.<br \/>\n<a href=\"http:\/\/education.surgery.ufl.edu\/Lectures\/CAESAR.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Cao P, De Rango P, Verzini F, Parlani G, et al for the CAESAR Trial Group. Comparison of Surveillance versus aortic endografting for small aneurysm repair (CAESAR): results from a randomised trial.<\/a>\u00a0Eur J Vasc Endovasc Surg 2011; 41: 13-25.<br \/>\n<a href=\"http:\/\/zarinslab.stanford.edu\/publications\/zarins_bib\/zarins_pdf\/2010\/ouriel_repair_jvs10.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Ouriel K, Clair DG, Kemt KC, Zarins CK. Positive impact of endovascular options for treating aneurysms early (PIVOTAL) investigators. Endovascular repair compared with surveillance for patients with small abdominal aortic aneurysms.\u00a0<\/a>J Vasc Surg 2010; 51: 1081-7.<br \/>\n<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22840907\" target=\"_blank\" rel=\"noreferrer noopener\">Kuzmik GA, Sang AX, ElefteriadesJA. Natural history of thoracic aortic aneurysms.<\/a>\u00a0J Vasc Surg 2012;56(2): 565-71.<br \/>\n<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15227687\" target=\"_blank\" rel=\"noreferrer noopener\">Gorham TJ, Taylor J, Raptis S. Endovascular treatment of abdominal aortic aneurysm.<\/a>\u00a0Brit J Surg 2004; 91: 815-827.<br \/>\n<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15111875\" target=\"_blank\" rel=\"noreferrer noopener\">Rutherford RB and Krupski WC. Current status of open versus endovascular stent-graft repair of abdominal aortic aneurysm.\u00a0<\/a>J Vasc Surg 2004; 39(5): 1129-1139.<br \/>\n<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15978908\" target=\"_blank\" rel=\"noreferrer noopener\">Cronenwett JL. Endovascular aneurysm repair: important mid-term results.<\/a>\u00a0Lancet 2005; 365: 2156-58.<br \/>\n<a href=\"http:\/\/www.nejm.org\/doi\/pdf\/10.1056\/NEJMoa042002\" target=\"_blank\" rel=\"noreferrer noopener\">Prinssen M, Verhoeven ELG, Buth J et al. A randomised trial comparing conventional and endovascular repair of abdominal aortic aneurysms.<\/a>\u00a0New Engl J Med 2004; 351: 1607-18.<br \/>\n<a href=\"http:\/\/www.aneurismas.com.br\/adm\/fotos\/060b0cb8a67bf4ccfc95c7c31021511c.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Greenhalgh RM, Brown LC, Kwong GP, Powell JT, Thompson SG. Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30 day operative mortality results: randomised controlled trial.<\/a>\u00a0Lancet 2004; 364: 843-8.<br \/>\n<a href=\"http:\/\/www.nejm.org\/doi\/pdf\/10.1056\/NEJMoa051255\" target=\"_blank\" rel=\"noreferrer noopener\">Blankensteijn JD, de Jong SECA, Prinssen M et al. Two-year outcomes after conventional or endovascular repair of abdominal aortic aneurysms.<\/a>\u00a0N Engl J Med 2005; 352: 2398-405.<br \/>\n<a href=\"http:\/\/academicdepartments.musc.edu\/surgery\/education\/journal_club\/08-09\/october1.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Evar Trial Participants.\u00a0 Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR-1): randomised controlled trial.<\/a>\u00a0Lancet 2005; 365: 2179-86.<br \/>\n<a href=\"http:\/\/www.nejm.org\/doi\/pdf\/10.1056\/NEJMoa0909499\" target=\"_blank\" rel=\"noreferrer noopener\">De Bruin JL Baas AF, Buth J et al. Long term outcome of open or endovascular repair of abdominal aortic aneurysm.<\/a>\u00a0N Engl J Med 2010; 362: 1881-9.<br \/>\n<a href=\"http:\/\/www.nejm.org\/doi\/pdf\/10.1056\/NEJMoa0909305\" target=\"_blank\" rel=\"noreferrer noopener\">The United Kingdom EVAR Trial Investigators.The United Kingdom EVAR Trial Investigators. Endovascular versus Open repair of abdominal aortic aneurysm.<\/a>\u00a0N Engl J Med 2010; 362: 1863-71.<br \/>\n<a href=\"http:\/\/www.nejm.org\/doi\/pdf\/10.1056\/NEJMoa0911056\" target=\"_blank\" rel=\"noreferrer noopener\">The United Kingdom EVAR Trial Investigators. Endovascular repair of aortic aneurysm in patients physically ineligible for open repair.<\/a>\u00a0N Engl J Med 2010; 362: 1872-80.<br \/>\n<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20235086\" target=\"_blank\" rel=\"noreferrer noopener\">Karthikesalingam A, Holt PJE, Hinchcliffe RJ et al. Risk of reintervention after endovascular aortic aneurysm repair.<\/a>\u00a0Brit J Surg 2010; 97: 657-663.<br \/>\n<a href=\"http:\/\/www.nejm.org\/doi\/pdf\/10.1056\/NEJMe048258\" target=\"_blank\" rel=\"noreferrer noopener\">Lederle FA. Abdominal aortic aneurysm \u2013 open versus endovascular repair.\u00a0<\/a>New Engl J Med 2004; 351: 1677-79.<br \/>\n<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15978926\" target=\"_blank\" rel=\"noreferrer noopener\">EVAR Trial Participants. Endovascular aneurysm repair and outcome in patients unfit for open repair of abdominal aortic aneurysm.<\/a>\u00a0Lancet 2005; 365: 2187-92.<br \/>\n<a href=\"http:\/\/ac.els-cdn.com\/S0741521405019087\/1-s2.0-S0741521405019087-main.pdf?_tid=cc51a0e2-86fd-11e2-9515-00000aab0f6b&amp;acdnat=1362643718_32fdca115bd300636cf1aa4cd0ba0c07\" target=\"_blank\" rel=\"noreferrer noopener\">Nowygrod R, Egorova N, Greco G et al. Trends, complications, and mortality in peripheral vascular surgery.<\/a>\u00a0J Vasc Surg 2006; 43: 205-216.<br \/>\n<a href=\"http:\/\/www.vhpharmsci.com\/decisionmaking\/Therapeutic_Decision_Making\/Intermediate_files\/ACE%20inhibitors%20and%20aortic%20rupture-%20a%20population-based%20case-control%20study-Lancet.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Hackam DG, Thiruchelvam D, Redelmeier D. Angiotensin-converting enzyme inhibitors and aortic rupture: a population-based case-control study.<\/a> Lancet 2006; 368: 659-65.<\/p>\n<\/div>\n<\/article>\n<p>&nbsp;<\/p>\n<\/div>\n<aside id=\"secondary\" class=\"widget-area\" aria-label=\"Blog Sidebar\">\n<section id=\"wppb-login-widget-3\" class=\"widget login\">\n<div id=\"wppb-login-wrap\" class=\"wppb-user-forms\">\n<p class=\"login-register-lost-password\">\n<\/div>\n<\/section>\n<\/aside>\n[\/vc_column_text][\/vc_tta_section][\/vc_tta_tour][\/vc_column][\/vc_row]\n<\/div>","protected":false},"excerpt":{"rendered":"<p>[vc_row full_width=&#8221;stretch_row&#8221; content_placement=&#8221;middle&#8221; equal_height=&#8221;yes&#8221; rtl_reverse=&#8221;yes&#8221; remove_bottom_col_margin=&#8221;true&#8221; columns_right=&#8221;yes&#8221; wpex_bg_color=&#8221;#03a3de&#8221; min_height=&#8221;350px&#8221;][vc_column width=&#8221;1\/2&#8243;][\/vc_column][vc_column width=&#8221;1\/2&#8243;][vc_column_text css=&#8221;.vc_custom_1759281906916{padding-top: 20px !important;padding-bottom: 20px !important;}&#8221; color=&#8221;#fefefe&#8221;] Aortic Aneurysm [\/vc_column_text][\/vc_column][\/vc_row][vc_row css=&#8221;.vc_custom_1759015527111{margin-top: 60px !important;}&#8221;][vc_column][vc_tta_tour controls_size=&#8221;md&#8221; active_section=&#8221;1&#8243;][vc_tta_section title=&#8221;What is an abdominal aortic aneurysm?&#8221; tab_id=&#8221;1759012899351-dcaaabe1-cd5c883d-10e2&#8243;][vc_column_text css=&#8221;&#8221;] What is an abdominal aortic aneurysm? &nbsp; An aneurysm is a swelling or dilatation in a blood vessel.\u00a0 Aneurysms can occur in&hellip;<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-64","page","type-page","status-publish","hentry","entry","no-media"],"_links":{"self":[{"href":"https:\/\/cmcdeploytwo.co.nz\/vsoanz\/index.php\/wp-json\/wp\/v2\/pages\/64","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cmcdeploytwo.co.nz\/vsoanz\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/cmcdeploytwo.co.nz\/vsoanz\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/cmcdeploytwo.co.nz\/vsoanz\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/cmcdeploytwo.co.nz\/vsoanz\/index.php\/wp-json\/wp\/v2\/comments?post=64"}],"version-history":[{"count":5,"href":"https:\/\/cmcdeploytwo.co.nz\/vsoanz\/index.php\/wp-json\/wp\/v2\/pages\/64\/revisions"}],"predecessor-version":[{"id":237,"href":"https:\/\/cmcdeploytwo.co.nz\/vsoanz\/index.php\/wp-json\/wp\/v2\/pages\/64\/revisions\/237"}],"wp:attachment":[{"href":"https:\/\/cmcdeploytwo.co.nz\/vsoanz\/index.php\/wp-json\/wp\/v2\/media?parent=64"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}