68ys screen detected AAA male with a past history of hypertension and prostate cancer stage 3 under hormonal treatment for 4ys with stable PSA. No other significant medical conditions. Fit and active walks 5 miles 3-times a week Aneurysm now 5.7 on CTA and it was found to be anatomically suitable for EVAR.
Assume you assessed him clinically
1- What investigations you would like to request?
2- Patient read about both modalities of repair and asks for your advice, what would you recommend?
3- Taking your advice, he is more inclined towards OSR, do you agree or disagree and why?
4- He asks about recovery, possible risks ,follow up protocol of OSR and the likelihood of needing further interventions compared to standard infra-renal EVAR?
5- Could you please give comment on available evidence that you may use to make your decision?
21 Comments
Yasmin Mosbah
1-Full labs
Echo & PFTs
Cardio & anesthesia consultation
2-According to this patient, he is fit & relatively active but he is old age with medical history of HTN & prostate cancer stage 3
I would recommend EVAR as it is lesss invasive , less hospital stay postop , less risk of complications & less risk of morbidity & mortality
3-I disagree with OSR , as I said earlier , OSR can be the best option in younger patient with better general condition & no medical history of other chronic diseases to be able to withstand the high stress of this major invasive operation & for better outcome & early revcovery & rehabilitation & be able to withstand the management of complications if present
4-OSR -longer hospital stay stop & may be even longer stay in ICU postoperative , longer recovery time & rehabilitation to return back to normal daily life at least 6 ms , high complications like bowel ischemia , renal infarction, cardiac affection especially , follow up post op of the vital signs , bowel movement, wound change , bigger incision , higher risk of wound infection , risk of incisional hernia , & follow-up in the clinic by CTA & clinically
OSR in young for patients with no comorbidities & no complications post op may need no further intervention for longer period of time then EVAR
5-The 2024 European Society for Vascular Surgery (ESVS) Clinical Practice Guidelines provide comprehensive recommendations for managing abdominal aortic aneurysms (AAA), particularly concerning the choice between endovascular aneurysm repair (EVAR) and open surgical repair (OSR).
1- What investigations you would like to request?
I will request full lab like CBC, liver function test, kidney function tests
Eco cardiography, CPET and pulmonary function test
Then consultation of cardiology pulmonology and anesthesia consultant
2- Patient read about both modalities of repair and asks for your advice, what would you recommend?
I will tell him about a technique of both modalities in general and I will elaborate the benefits of surgery in being durable and it is suitable more for patients with low risk from cardiac and pulmonlogical aspects.
So we should complete the investigations and the cardio pulmonary tests to assess fitness for surgery.
Notice that both interventions have complication rate and the procedure is a major procedure in both interventions.
3- Taking your advice, he is more inclined towards OSR, do you agree or disagree and why?
After seeing his investigations the patient was fit for surgery as his cardi pulmonary tests were fair. So I can proceed to open surgical repair considering the complications.
Notice that I will contact a urologist and serve the net for evidence about prognosis of the prosthetic cancer. If it has short life expectancy EVAR should be the first option. (I have found that these cases have 10 year life expectancy about 80% which is very high suitability for open surgical repair
4- He asks about recovery, possible risks ,follow up protocol of OSR and the likelihood of needing further interventions compared to standard infra-renal EVAR?
The recovery after operation can be about three days after the operation initially in ICU then in the inpatient. During this period we will follow up Labs and vital data like pulse blood pressure saturation urine output etc
Then you will need about two to three weeks to recover from the operation removes stitches and rehabilitation with physiotherapy would be done during this period and beyond.
The operation is a major operation so we have possible risks like cardiac complications (heart attack), a kidney maybe affected from decreasing blood flow to it, some bleeding may occur around the sutures, the surgical wound may be infected or inflamed.
Reintervention rate is more with EVAR than open surgical repair, but consider that we may need reintervention in cases of major complications like suspicion of injury of the intestine from ischemia or major bleeding.
5- Could you please give comment on available evidence that you may use to make your decision?
Esvs guidelines and NICE guidelines recently recommended open surgical repair for fit patients, non-ruptured atomically suitable cases as the first option.
A1- labs (cbc- creat – coagulation -albumin)
ECG echo
pulmonary function test
CPET
A2- according to patient fitness and age we will decide our intervention
as patient is cardiac fit and relatively young we should go with osr
but if he is cardiac we should go with EVAR
A3-yes if he is generally fit as it is durable and don’t need long surveillance
A4- OSR associated with high perioperative morbidity and long hospital stay
but it is more durable and and have low risk of reintervention
A1: Routine lab investigations, ECHO, ECG and CPET
A2 & A3: I recommend EVAR as it is less invasive and less morbidity and mortality. I would disagree with the patient and strongly recommend EVAR, however, OSR remains an option in fit patients.
A4: Risk of infection, bowel ischemia, longer recovery up to 6 months, MI and stroke perioperatively
In addition to the CTA (Computed Tomography Angiography) already performed (which shows a 5.7 cm AAA anatomically suitable for EVAR), the following investigations would be important: Cardiopulmonary and General Fitness:
ECG – to assess for arrhythmias or ischemia.
Echocardiogram – to evaluate left ventricular function, especially given his hypertension.
Cardiopulmonary exercise testing (CPET) or dobutamine stress echo (DSE) – for a comprehensive risk stratification, especially if considering open repair (OSR).
Pulmonary function tests (PFTs) – to assess respiratory reserve for OSR.
Routine bloods:
——– My recommendation: Since he is fit, younger, and likely to live >10–15 years, OSR may be preferableif he accepts the upfront surgical risks. However, EVAR remains a reasonable choice, especially if he strongly values shorter recovery and less invasiveness.————
I Agree with his decision
He is young and fit, with a life expectancy >10–15 years.
——————–
Recovery (OSR):
Hospital stay: ~5–10 days.
Return to full function: ~6–12 weeks.
Initial limitations: No heavy lifting for ~6 weeks, gradual increase in activity.
Risks of OSR:
Perioperative mortality: ~3–5% (less in high-volume centres).
Thanks for your answer
I would appreciate your own personal plan with concise directed answer
try please to minimise use of AI in structuring your answer
Q1
Investigation
Lab:
Cbc- pt-creat-lipid profiles-s albumin
Ecg
Eeg
Radiology
Ct
Echo
Cpet
Pulm function
Q2
Evar has less perioperative morbidity and mortality with ptolonged followup perial with higher incidence of propability of reintervention
On other side OSR has more peri operative mortality and morbidity with longer durability and less follow up with low incidence rate of delayed intervention
Q3
Pt is fit for OSR but older age preferred for Evar but no contraindication for OSR
So , we can proceed for OSR with its risks as pt is accepted for this
Q4
Recover period 2:3 months
Hospital stay at OSR from 2:3 wks
Periop complication : mi , stroke , bleeding even death
Re intervention in case of bleeding , thrombosis, infection
Q5
Evar uk 1
DREAM trial
Thanks for your answers
Regarding investigations either echo/PFT or CPET needed
EEG not necessary unless there is indication
I like the rationale for choosing and supporting decision
Regards
• Blood tests (CBC, U&E, LFTs), ECG, echocardiogram, PFTs, CPET if needed, and crossmatch.
• I recommend EVAR — it’s less invasive, safer in the short term, and recovery is quicker.
• I disagree with choosing OSR — EVAR offers similar results with lower early risk and less stress on the body.
• OSR needs longer recovery (4–6 weeks), has higher early risk (bleeding, infection), but fewer reinterventions.
EVAR allows faster recovery (1–2 weeks), lower early risk, but needs lifelong imaging and may need further procedures.
• Trials like EVAR-1 and DREAM show lower short-term mortality with EVAR. OSR may last longer, but EVAR is preferred in fit patients with suitable anatomy.
Thanks for your answer
I would have further discussion about choosing EVAR over OSR in this patient
The durability and evidence would support OSR over EVAR in such fit patient with long life expectency
I beleive looking at the options from patient prospective would have more drive on decision
More evidence details needs to be included to justify the decision
Regards
A1
Cbc
Pt ptt inr
Urea creat
ALT Ast
ECHO
.
A2
I will advice to EVAR
.
A3
EVAR Is more safe on pt with multiple diseases
EVAR Has perioperative less rate mortality and morbidity
EVAR may be have some weakness like reintervention and no role in distorted anatomy
.
A4
Possible risks
Infection
Cvs complication like MI or arrthymia
Bowel ischemia specially larg colon
Bleeding
Neurological
Lower limb ischemia
UPto death
..
Stay in Icu for few days upyo 5 to 10 days in ward
Thanks for your answer
Would you like to have further investigative tool for pulmonary assessment
I beleive EVAR choice in this patient may need further discussion looking at his age and fitness and from durability prospect
The ICU stay and ward stay here is controversial , I would like to hear from you more on what basis that counted
I beleive some more evidence would be included to support your answers
A1. What investigations would you like to request?
In addition to the CTA already performed (which confirmed the size and anatomy), further investigations should include:
• Baseline blood tests: CBC, Urea & Electrolytes, LFTs, Coagulation profile, PSA (monitoring), Cross-match (if OSR is considered)
• cardiac assessment ECG – baseline cardiac function and Echocardiogram – to assess left ventricular function
• Pulmonary function tests – if OSR is being considered (major surgery)
• Anaesthetic assessment – to evaluate perioperative risk
• Duplex ultrasonography – for follow-up or if CTA images are inconclusive
• CPET– 6-minute walk test or cardiopulmonary exercise testing (CPET) if borderline candidate for OSR to assess cardiopulmonary and muscular function.
A2. Patient read about both modalities of repair and asks for your advice, what would you recommend?
Endovascular Aneurysm Repair (EVAR)
because of
Anatomically suitable for EVAR
Fit and active >Fits well with his active lifestyle
Life expectancy >10 years
Comorbidities under control
Minimally invasive With low perioperative morbidity and mortality
Faster recovery and Shorter hospital stay
However, discuss that EVAR may require:
• Lifelong imaging surveillance
• Higher rate of secondary interventions (e.g., endoleaks)
A3. Taking your advice, he is more inclined towards OSR, do you agree or disagree and why?
Disagree, but respect.
Reasons:
EVAR is generally preferred in anatomically suitable patients with controlled comorbidities
OSR has higher initial risks (e.g., MI, respiratory failure, bleeding)
Prolonged recovery and hospital stay
OSR offers a more durable repair with fewer long-term interventions but at higher upfront cost in terms of health
but I will agree and favor OSR if:
• Patient desires a one-time definitive solution with no need for future imaging
• Long-term durability is more important to him than early recovery
• He is particularly concerned about device-related complications
A4.He asks about recovery, possible risks ,follow up protocol of OSR and the likelihood of needing further interventions compared to standard infra-renal EVAR?
1.Recovery
EVAR > Shorter (3–5 days hospital stay, full recovery in ~2 weeks)
OSR > Longer (7–10 days stay, recovery up to 2–3 months)
2.Perioperative risk
EVAR > Lower mortality (1–2%)
OSR > Higher mortality (4–6%)
3.Reintervention rate
EVAR > Higher over 5–10 years (endoleaks, graft migration)
OSR > Very low once initial repair is successful
4.Follow-up
EVAR > Lifelong imaging (CT or US every 6–12 months)
OSR > Usually none after 1 year
5.Durability
EVAR > 60–70% freedom from reintervention at 10 years
OSR > more than 90% freedom from reintervention at 10 years
A5.Could you please give comment on available evidence that you may use to make your decision?
#Key Trials & Evidence:
EVAR-1 Trial (UK) > Short-term mortality lower in EVAR , No long-term survival benefit vs OSR and Higher reintervention rates in EVAR
DREAM Trial > Similar findings: EVAR had better perioperative outcomes but similar long-term mortality
OVER Trial (USA) > At 8 years, no significant difference in all-cause mortality and Reinterventions higher in EVAR group
Cochrane Reviews > EVAR is better in the short term, but OSR is more durable with fewer reinterventions
#Clinical Guidelines:
NICE (UK) and SVS (USA) suggest EVAR for patients who are anatomically suitable and at moderate to high surgical risk / OSR is considered for patients who are young, low-risk, and prefer durability over convenience
I think the answer is very full of information that needs review
I don’t think we follow methodical or structural algorithm of answer related to the case
There are some unneeded investigations
Good use of evidence
Thanks for your answer
I would rather ask you please to formulate your answer on your reading through the evidence with your own words
This answer is not practical or reflecting real life situation, I do not agree with the whole list of investigations, the chose of EVAR over OSR and I beleive we may have further discussion about using AI for formulating answers in this module
regards
A1..
I will ask for laboratory investigations as
CBC,LFT,KFT,Coagulation profile, and lipid profileinvedtigation to assess patient general condition as
ECG and ECHO for cardiac status
CPET exam for cardiac pulmonary and muscle evaluation
A2.. I will advice him for EVAR as it has less complications and more safe comparable to OSR
A3..
MY agreement or disagreement will depend on patient general condition and results of the investigation if he is fit generally for surgery and anaethesia and it is his desire so I will agree with him and the reverse is true
A4..OSR will require more post operative care than EVAR
In OSR patient will need post operative ICU admission with prolonged hospital stay while EVAR is more easy and will not required long hospital stay
OSR will have more complications as cardiac, pulmonary, renal, and bowel ischemia compared to EVAR
OF course EVAR has complications as endoleak and stent migration bur generally it is more favourable than open surgery if the patient has suitable EVAR. Criteria
A5…
The UK small aneurysm trial support that 5.5 cm is the cut off value for intervention and this patient aneurysm size is 5.7
Several trials were made to compare between EVAR and OSR AS EVAR1, OVER, and DREAM trials and all shows significant reducer 30 day mortality in EVAR will both long term results were nearly the same and also EVAR may require more reintervention than OSR
Thanks for your answer
1) do we need to Echo and CPET or we can only rely on CPET for pre-operative cardio-pulmonary assessment
2) Why EVAR is better (what is guidelines and evidence support your choice please)
3) Would EVAR does not hold cardiac, pulmonary,enal and ischemic complications and what is the mortality risk with EVAR please?
4) In what domain EVAR is easier for treatment, and would easier would be the standard to measure what is for patient best interest?
1-Full labs
Echo & PFTs
Cardio & anesthesia consultation
2-According to this patient, he is fit & relatively active but he is old age with medical history of HTN & prostate cancer stage 3
I would recommend EVAR as it is lesss invasive , less hospital stay postop , less risk of complications & less risk of morbidity & mortality
3-I disagree with OSR , as I said earlier , OSR can be the best option in younger patient with better general condition & no medical history of other chronic diseases to be able to withstand the high stress of this major invasive operation & for better outcome & early revcovery & rehabilitation & be able to withstand the management of complications if present
4-OSR -longer hospital stay stop & may be even longer stay in ICU postoperative , longer recovery time & rehabilitation to return back to normal daily life at least 6 ms , high complications like bowel ischemia , renal infarction, cardiac affection especially , follow up post op of the vital signs , bowel movement, wound change , bigger incision , higher risk of wound infection , risk of incisional hernia , & follow-up in the clinic by CTA & clinically
OSR in young for patients with no comorbidities & no complications post op may need no further intervention for longer period of time then EVAR
5-The 2024 European Society for Vascular Surgery (ESVS) Clinical Practice Guidelines provide comprehensive recommendations for managing abdominal aortic aneurysms (AAA), particularly concerning the choice between endovascular aneurysm repair (EVAR) and open surgical repair (OSR).
1- What investigations you would like to request?
I will request full lab like CBC, liver function test, kidney function tests
Eco cardiography, CPET and pulmonary function test
Then consultation of cardiology pulmonology and anesthesia consultant
2- Patient read about both modalities of repair and asks for your advice, what would you recommend?
I will tell him about a technique of both modalities in general and I will elaborate the benefits of surgery in being durable and it is suitable more for patients with low risk from cardiac and pulmonlogical aspects.
So we should complete the investigations and the cardio pulmonary tests to assess fitness for surgery.
Notice that both interventions have complication rate and the procedure is a major procedure in both interventions.
3- Taking your advice, he is more inclined towards OSR, do you agree or disagree and why?
After seeing his investigations the patient was fit for surgery as his cardi pulmonary tests were fair. So I can proceed to open surgical repair considering the complications.
Notice that I will contact a urologist and serve the net for evidence about prognosis of the prosthetic cancer. If it has short life expectancy EVAR should be the first option. (I have found that these cases have 10 year life expectancy about 80% which is very high suitability for open surgical repair
4- He asks about recovery, possible risks ,follow up protocol of OSR and the likelihood of needing further interventions compared to standard infra-renal EVAR?
The recovery after operation can be about three days after the operation initially in ICU then in the inpatient. During this period we will follow up Labs and vital data like pulse blood pressure saturation urine output etc
Then you will need about two to three weeks to recover from the operation removes stitches and rehabilitation with physiotherapy would be done during this period and beyond.
The operation is a major operation so we have possible risks like cardiac complications (heart attack), a kidney maybe affected from decreasing blood flow to it, some bleeding may occur around the sutures, the surgical wound may be infected or inflamed.
Reintervention rate is more with EVAR than open surgical repair, but consider that we may need reintervention in cases of major complications like suspicion of injury of the intestine from ischemia or major bleeding.
5- Could you please give comment on available evidence that you may use to make your decision?
Esvs guidelines and NICE guidelines recently recommended open surgical repair for fit patients, non-ruptured atomically suitable cases as the first option.
A1- labs (cbc- creat – coagulation -albumin)
ECG echo
pulmonary function test
CPET
A2- according to patient fitness and age we will decide our intervention
as patient is cardiac fit and relatively young we should go with osr
but if he is cardiac we should go with EVAR
A3-yes if he is generally fit as it is durable and don’t need long surveillance
A4- OSR associated with high perioperative morbidity and long hospital stay
but it is more durable and and have low risk of reintervention
A5 EVAR trail 1
ESVS guild lines
nice guildlines
A1: Routine lab investigations, ECHO, ECG and CPET
A2 & A3: I recommend EVAR as it is less invasive and less morbidity and mortality. I would disagree with the patient and strongly recommend EVAR, however, OSR remains an option in fit patients.
A4: Risk of infection, bowel ischemia, longer recovery up to 6 months, MI and stroke perioperatively
A5: EVAR UK1 trial and NICE 2025 guidelines
Thanks for your answer
I would like to discuss more with you of choice of EVAR over OSR
Q1.
The routine lab investigations plus Echocardiography, myocardial perfusion scan, and CPET
Q2 Actually I would recommend OSR if his investigations results came good and he is fit
Q3 I will agree with him towards OSR, as it is preferable for fit patients
Q4 and of course OSR has more risks and longer period for recovery up to 3 to 6 months
Q5 ESVS 2024 / NICE NG156 2025 guidelines Recommend OSR first‐line for fit patients; reserve EVAR for hostile abdomen or prohibitive surgical risk
Thanks
Good methodical approach
In addition to the CTA (Computed Tomography Angiography) already performed (which shows a 5.7 cm AAA anatomically suitable for EVAR), the following investigations would be important:
Cardiopulmonary and General Fitness:
——–
My recommendation: Since he is fit, younger, and likely to live >10–15 years, OSR may be preferableif he accepts the upfront surgical risks. However, EVAR remains a reasonable choice, especially if he strongly values shorter recovery and less invasiveness.————
I Agree with his decision
He is young and fit, with a life expectancy >10–15 years.
——————–
Recovery (OSR):
Risks of OSR:
Follow-up Protocol:
Likelihood of further interventions:
———————–
EVAR-1 trial (NEJM 2005, long-term follow-up 2010 & 2016):
Thanks for your answer
I would appreciate your own personal plan with concise directed answer
try please to minimise use of AI in structuring your answer
Q1
Investigation
Lab:
Cbc- pt-creat-lipid profiles-s albumin
Ecg
Eeg
Radiology
Ct
Echo
Cpet
Pulm function
Q2
Evar has less perioperative morbidity and mortality with ptolonged followup perial with higher incidence of propability of reintervention
On other side OSR has more peri operative mortality and morbidity with longer durability and less follow up with low incidence rate of delayed intervention
Q3
Pt is fit for OSR but older age preferred for Evar but no contraindication for OSR
So , we can proceed for OSR with its risks as pt is accepted for this
Q4
Recover period 2:3 months
Hospital stay at OSR from 2:3 wks
Periop complication : mi , stroke , bleeding even death
Re intervention in case of bleeding , thrombosis, infection
Q5
Evar uk 1
DREAM trial
Thanks for your answers
Regarding investigations either echo/PFT or CPET needed
EEG not necessary unless there is indication
I like the rationale for choosing and supporting decision
Regards
• Blood tests (CBC, U&E, LFTs), ECG, echocardiogram, PFTs, CPET if needed, and crossmatch.
• I recommend EVAR — it’s less invasive, safer in the short term, and recovery is quicker.
• I disagree with choosing OSR — EVAR offers similar results with lower early risk and less stress on the body.
• OSR needs longer recovery (4–6 weeks), has higher early risk (bleeding, infection), but fewer reinterventions.
EVAR allows faster recovery (1–2 weeks), lower early risk, but needs lifelong imaging and may need further procedures.
• Trials like EVAR-1 and DREAM show lower short-term mortality with EVAR. OSR may last longer, but EVAR is preferred in fit patients with suitable anatomy.
Thanks for your answer
I would have further discussion about choosing EVAR over OSR in this patient
The durability and evidence would support OSR over EVAR in such fit patient with long life expectency
I beleive looking at the options from patient prospective would have more drive on decision
More evidence details needs to be included to justify the decision
Regards
A1
Cbc
Pt ptt inr
Urea creat
ALT Ast
ECHO
.
A2
I will advice to EVAR
.
A3
EVAR Is more safe on pt with multiple diseases
EVAR Has perioperative less rate mortality and morbidity
EVAR may be have some weakness like reintervention and no role in distorted anatomy
.
A4
Possible risks
Infection
Cvs complication like MI or arrthymia
Bowel ischemia specially larg colon
Bleeding
Neurological
Lower limb ischemia
UPto death
..
Stay in Icu for few days upyo 5 to 10 days in ward
…….
A5
EVAR 1 trial
uk small aneurysm trial
Thanks for your answer
Would you like to have further investigative tool for pulmonary assessment
I beleive EVAR choice in this patient may need further discussion looking at his age and fitness and from durability prospect
The ICU stay and ward stay here is controversial , I would like to hear from you more on what basis that counted
I beleive some more evidence would be included to support your answers
A1.
Cbc
Pt ptt inr
Urea creat
A1. What investigations would you like to request?
In addition to the CTA already performed (which confirmed the size and anatomy), further investigations should include:
• Baseline blood tests: CBC, Urea & Electrolytes, LFTs, Coagulation profile, PSA (monitoring), Cross-match (if OSR is considered)
• cardiac assessment ECG – baseline cardiac function and Echocardiogram – to assess left ventricular function
• Pulmonary function tests – if OSR is being considered (major surgery)
• Anaesthetic assessment – to evaluate perioperative risk
• Duplex ultrasonography – for follow-up or if CTA images are inconclusive
• CPET– 6-minute walk test or cardiopulmonary exercise testing (CPET) if borderline candidate for OSR to assess cardiopulmonary and muscular function.
A2. Patient read about both modalities of repair and asks for your advice, what would you recommend?
Endovascular Aneurysm Repair (EVAR)
because of
However, discuss that EVAR may require:
• Lifelong imaging surveillance
• Higher rate of secondary interventions (e.g., endoleaks)
A3. Taking your advice, he is more inclined towards OSR, do you agree or disagree and why?
Disagree, but respect.
Reasons:
but I will agree and favor OSR if:
• Patient desires a one-time definitive solution with no need for future imaging
• Long-term durability is more important to him than early recovery
• He is particularly concerned about device-related complications
A4.He asks about recovery, possible risks ,follow up protocol of OSR and the likelihood of needing further interventions compared to standard infra-renal EVAR?
1.Recovery
2.Perioperative risk
3.Reintervention rate
4.Follow-up
5.Durability
6.Risks
A5.Could you please give comment on available evidence that you may use to make your decision?
#Key Trials & Evidence:
#Clinical Guidelines:
I think the answer is very full of information that needs review
I don’t think we follow methodical or structural algorithm of answer related to the case
There are some unneeded investigations
Good use of evidence
Thanks for your answer
I would rather ask you please to formulate your answer on your reading through the evidence with your own words
This answer is not practical or reflecting real life situation, I do not agree with the whole list of investigations, the chose of EVAR over OSR and I beleive we may have further discussion about using AI for formulating answers in this module
regards
A1..
I will ask for laboratory investigations as
CBC,LFT,KFT,Coagulation profile, and lipid profileinvedtigation to assess patient general condition as
ECG and ECHO for cardiac status
CPET exam for cardiac pulmonary and muscle evaluation
A2.. I will advice him for EVAR as it has less complications and more safe comparable to OSR
A3..
MY agreement or disagreement will depend on patient general condition and results of the investigation if he is fit generally for surgery and anaethesia and it is his desire so I will agree with him and the reverse is true
A4..OSR will require more post operative care than EVAR
In OSR patient will need post operative ICU admission with prolonged hospital stay while EVAR is more easy and will not required long hospital stay
OSR will have more complications as cardiac, pulmonary, renal, and bowel ischemia compared to EVAR
OF course EVAR has complications as endoleak and stent migration bur generally it is more favourable than open surgery if the patient has suitable EVAR. Criteria
A5…
The UK small aneurysm trial support that 5.5 cm is the cut off value for intervention and this patient aneurysm size is 5.7
Several trials were made to compare between EVAR and OSR AS EVAR1, OVER, and DREAM trials and all shows significant reducer 30 day mortality in EVAR will both long term results were nearly the same and also EVAR may require more reintervention than OSR
Thanks for your answer
1) do we need to Echo and CPET or we can only rely on CPET for pre-operative cardio-pulmonary assessment
2) Why EVAR is better (what is guidelines and evidence support your choice please)
3) Would EVAR does not hold cardiac, pulmonary,enal and ischemic complications and what is the mortality risk with EVAR please?
4) In what domain EVAR is easier for treatment, and would easier would be the standard to measure what is for patient best interest?