What are the risks and benefits associated with aneurysm repair?

What other risks are associated with aneurysm repairs? Risks, okay well there are a number of risks which I tend to subdivide, if we're looking at keyhole repair to start off with, we can talk about stent graft related risks, so the chance of forming a leak around that stent, the chance of needing re-intervention, the chance of developing an occluded limb of a stent graft, so those sort of factors need to be discussed, so stent graft related risks are of relevance. And then there are more patient-specific risks, so the chance of having a heart attack or a stroke stroke, or of developing kidney failure. So when you deploy a stent, you inject the patient with quite a lot of dye, which is used to light up the vessels on x-ray, which is the main modality we use for putting stents in. And the dye can sit in the tubules of the kidney and cause temporary renal failure, actually, so derangement of kidney function. So, you know, that risk needs to be talked about as well. And then, you know, on the flip side of that, if you look at, so going back to stent graft repair and then the longer term risks need to be discussed, so the need for reintervention and the need for ongoing surveillance. If you then look at the risks of open surgery, I tend to consider open surgery as very much an investment because the mortality is higher. So we're talking for an open repair. I mean, you know, ballpark figure might be 4% or thereabouts. And that's in the sort of early, early stages, post-operatively, in terms of actually not making it through to discharge. So that needs to be discussed. But as discussed before, in the longer term, we, at least given the current data, we think there is a survival benefit attributed to those people who make that initial investment and then survive on through, you know, five years to a decade beyond the repair, in that they don't require routine surveillance. I mean, a lot of people will arrange a CT scan at five years just to keep an eye on the aneurysm itself and just to make sure that other segments of the aorta haven't dilated up. But again, don't need repeated CTs, they don't need usually don't need repeated re-interventions and so those those those aspects very much go in favor actually offering open repair so yeah so again when talking about repair is important to talk about mortality rates I think to a patient and it's important to explain that you know particularly for younger patients who are otherwise fairly fit, that they do make an initial investment and take a risk in terms of the short-term survival, but in the longer term the idea being that they do reasonably well. So those are things that definitely need to be rolled into a conversation with the patient.