What is important when determining treatment options for an aneurysm repair?

What is important when determining treatment options for an aneurysm repair? You know in terms of for both aortic aneurysm surgery and for carotids I think you know the conversation that you have with the patient at the beginning is really really important and I also strongly believe that the best operation should be offered to the patient not on the basis of, you know, what the unit prefers to do, whether it's, you know, EVAR or open surgery, but on the basis of what is actually the best for the patient on balance and probabilities. So, and that involves having experience in both techniques, really, particularly for aneurysm surgery. Does that process factor in social situations as well? I think very much. I think part of, you know, in the UK, you know, a lot of consent, a lot of the consent process is driven by something called the Montgomery Principle, which is essentially you have to talk about the risks which are of material importance to the patient. You know, for aneurysm repair, you know, in a male, for example, there is, you know, there is a risk of impotence. there's no getting around that because the nerves that supply well impotence and ejaculatory problems the nerves that supply that territory sit at the kind of where the aorta divides into the iliac arteries and so you know if you're consenting a say a 65 year old male who's just married for the third time over and about to go on his honeymoon for an aneurysm repair that might be something that needs to be discussed with them. Obviously for an elderly gentleman that might not be of any relevance whatsoever. So I think the point of that is is that any consent process needs to involve an understanding of where the patient's coming from, what their support network is and what their expectation is from the operation really.