Question 1

When is conservative treatment recommended for abdominal aortic aneurysms?

Accepted Answer

Conservative treatment is recommended for small, asymptomatic abdominal aortic aneurysms measuring less than 5.5 centimeters in diameter. This approach focuses on modifying risk factors such as tobacco cessation, managing hyperlipidemia, hypertension, and diabetes, and gradually increasing physical activity to prevent aneurysm growth and rupture.

Question 2

What monitoring schedule is used for different sizes of abdominal aortic aneurysms?

Accepted Answer

Aneurysm monitoring frequency depends on size. Small aneurysms measuring 4.0 to 5.4 centimeters require ultrasound or CT scans every 6 to 12 months. Aneurysms smaller than 4.0 centimeters are monitored every 2 to 3 years. This surveillance helps detect expansion early, allowing timely intervention when necessary.

Question 3

What are the key differences between open aneurysm repair and endovascular repair?

Accepted Answer

Open aneurysm repair involves a large abdominal incision where the surgeon removes thrombus or plaque and sutures a synthetic graft to the proximal and distal ends. Endovascular aneurysm repair is less invasive, placing a sutureless aortic graft inside the aneurysm via a femoral artery catheter, avoiding major abdominal surgery.

Question 4

When is surgical repair recommended for asymptomatic aneurysms?

Accepted Answer

Surgical repair is advised for asymptomatic aneurysms measuring 5.5 centimeters or larger. At this size threshold, the rupture risk increases significantly, making intervention necessary. The choice between open aneurysm repair and endovascular repair depends on patient factors and anatomical considerations.

Question 5

What is endoleak and why is it a concern after aneurysm repair?

Accepted Answer

Endoleak is the most common complication following abdominal aortic aneurysm repair, involving blood seeping back into the old aneurysm sac. It results from inadequate seal at graft ends, graft fabric tears, or leaks between overlapping segments. This complication can lead to continued aneurysm growth and potential rupture.

Question 6

What other complications can occur after aneurysm repair besides endoleak?

Accepted Answer

Additional complications include aneurysm growth above or below the graft, aortic dissection, bleeding, aneurysm rupture, renal artery occlusion from stent migration, incisional hematoma, infection at the incision site, and graft thrombosis. Angiography is performed after repair to check for leaks and ensure graft patency.

Question 7

How does surgical repair differ for iliac artery aneurysms versus saccular aneurysms?

Accepted Answer

Iliac artery aneurysm repair uses a bifurcated graft that replaces the entire affected segment. For saccular aneurysms, only the bulbous lesion is excised, and the artery is repaired using primary closure by suturing or applying an autogenous or synthetic patch graft. Both approaches aim to restore normal blood flow.

מפרצת III: טיפול בין מקצועי

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