Suitability far endovascular aneurysm repair in an unselected population

Background: Tertiary referral centres report that up to 60 per cent of pati ents may be suitable for endovascular repair of abdominal aortic aneurysm ( EVAR). The aim of this study was to determine the percentage of abdominal a ortic aneurysms (AAAs) presenting to a county-wide vascular service that me re suitable for EVAR, and to examine the outcome of subsequent AAA repair i n relation to aneurysm morphology. Patients and methods: All patients being assessed for AAA repair between Ja nuary 1998 and December 1999 underwent spiral computed tomography angiograp hy to determine aneurysm morphology and suitability for EVAR. Subsequent ou tcome for all patients in the study was recorded in a prospective vascular database. Results: A total of 115 patients was assessed. Sixty-three aneurysms (55 pe r cent) had one or more absolute contraindications to EVAR, a further 13 (1 1 per cent) had at least one relative contraindication, and 39 (34 per cent ) had no contraindication. Of patients with no absolute contraindication to EVAR, ten underwent successful EVAR, five did not meet recognized criteria for surgery, one awaits EVAR, four remain under observation, one awaits op en repair, and 31 underwent open repair without death. Conclusion: Only 30 per cent of unselected AAAs presenting to a vascular se rvice are entirely suitable for EVAR; most of these patients can safely und ergo open AAA repair. These data suggest that increased use of EVAR is only possible by deploying devices in suboptimal morphology, and in treating pa tients who would not normally be considered for open AAA repair.