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Abdominal aortic aneurysmectomy without preoperative angiography. A prospective study.
S G Friedman1, B A Kerner, K V Krishnasastry
1Department of Surgery, North Shore University Hospital, Manhasset, NY.
New York State Journal of Medicine
|April 1, 1990
Summary
Routine preoperative angiography is not necessary for elective abdominal aortic aneurysmectomy (AAA) unless specific indications exist. Computed tomography (CT) is a suitable alternative for preoperative evaluation, enabling outpatient workups.
Area of Science:
- Vascular Surgery
- Diagnostic Imaging
Background:
- Elective abdominal aortic aneurysmectomy (AAA) requires careful preoperative assessment.
- The necessity of routine preoperative angiography for AAA remains a subject of debate.
Purpose of the Study:
- To evaluate the necessity of routine preoperative angiography before elective abdominal aortic aneurysmectomy (AAA).
- To determine if selective use of angiography based on specific indications is sufficient.
Main Methods:
- A prospective study of 124 abdominal aortic aneurysm cases, with 110 undergoing elective AAA.
- Preoperative angiography was performed only for specific indications (hypertension, renal dysfunction, etc.).
- Comparison of outcomes between patients with and without preoperative angiography.
Main Results:
- Only 9.1% of patients (10/110) received preoperative angiography, altering operative strategy in 9 cases.
- 100 patients underwent elective AAA without preoperative aortography, with acceptable morbidity and mortality.
- Intraoperative findings included iliac aneurysms in 23% and accessory renal arteries in 2.7%.
Conclusions:
- Routine preoperative angiography is not essential for elective AAA when specific indications are absent.
- Computed tomography (CT) is recommended as the primary preoperative imaging modality for AAA.
- Outpatient computed tomography (CT) can effectively manage the preoperative workup for abdominal aortic aneurysms.