With all the modern advances in the treatment of Aortic Aneurysm, why is it necessary to do open aneurysm surgery?
First, Aortic aneurysm is indicated for treatment when the size is above 5.5 cm without symptoms. However, when a patient has abdominal and back pain and has an aneurysm bigger than 5.5cm, it is indicated to do this urgently, preferably in the same hospital admission.
Second, over 99 % of the aneurysm can be treated by stenting but there are times that the
aneurysm will require a customized (tailor-made) stent device and this will take up to 8 to 12 weeks to make. Hence, we cannot wait that long because the aneurysm would rupture.
Thirdly, when the anatomy is very complex, the risk of putting a stent inside a patient may not be lower than open surgery. Take an example a complex four-fenestrated stent (stent with 4 branches) used in the treatment of aortic aneurysm will have a 6 to 8 % 30-day mortality but open surgery will carry around a 5 % 30-day mortality risk.
Finally, there is very good scientific data that if the patient is young and can live beyond 5 years, open surgery does better with less intervention and the National Institute of Clinical Excellence Guidelines in the UK still recommend open surgery as a first line of treatment.
This gentleman had a successful open AAA repair by Dr Tang and Dr Wong 6 months ago. he is now back playing golf. His midline abdominal wound has healed up nicely and he now won’t need any surveillance CT scans for his abdominal aortic repair compared to if he had an endovascular stent repair which would need lifelong surveillance
