Aortic aneurysm repair

So we're now going to talk a little bit about Choices when we were talking about aortic aneurysm repair and You are likely to be offered two treatment modalities for your aortic aneurysm One is open surgical repair and one is stent graft repair or EVAR And this subject is Being the subject of intense scrutiny really ever since EVAR first started in 1991 and there's actually some nice guidance that is due to be released in November 2018 which will be available to the public if you want to read about this in more detail. So if we talk about stent graft first, the advantages of a stent graft are Fundamentally, it's a much smaller procedure for the patient, so it involves making either one or two small cuts over the femoral arteries, can even be done under local anaesthetic. We then slide the stent graft up into the aorta, deploy the stent graft, and it seals the aneurysm. That's really the end of the procedure. Most people will spend two or maybe three days in hospital afterwards, but we're increasingly trying to perform EVAR as a day case procedure where you're really in the hospital for 23 hours. So the principal advantage is that it's much less of an operation and actually carries less risk of danger at the time of surgery. So the mortality for EVAR is very low, less than one percent. The disadvantages however are the durability because although an open aneurysm operation involves a cut in the belly and a stay, usually in an intensive care or a high-dependency unit for a couple of days and a week in hospital, once the open operation has been done, it's a much more durable long-term procedure. So in a way, if you have the open operation, you're front-loading your risk to the day of surgery and your chances of dying are slightly higher and your chances of having a post-operative complication is slightly higher and you will be in hospital for longer, but once you're out of hospital then the issue is nearly always done and dusted forever and you don't need long-term follow-up, you don't need long-term surveillance, you don't need to keep going back to the hospital. Whereas with EVAR we will need to scan you on at least an annual basis for the rest of your life because the endografts are not as durable and sometimes they slip down the aorta and cause a leak and the aneurysm repressurises or sometimes you can get a leakage of blood around the graft and the aneurysm reperfuses and that's called an endoleak. So you trade a smaller operation at the time of surgery for a lifetime of surveillance and you have a 10% between a 5% and 10% chance every year of having to have more done to the the graft to keep it working properly, either a balloon or extending the stent or trying to seal one of these endo leaks. So in general terms if you're fit and if you're young then you're much better off with an open operation. If you're elderly or if you have other diseases that make you higher risk you're probably better off having an endovascular repair.