NICE Appraisal Of Endovascular Stent Grafts For Abdominal Aortic Aneurysms

Main Category: Vascular
Also Included In: Heart Disease
Article Date: 25 Feb 2009 - 7:00 PDT

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The National Institute for Health and Clinical Excellence (NICE) has today (25 February) published final guidance on the use of endovascular stent grafts for the treatment of infra-renal abdominal aortic aneurysms (AAA). Aortic aneurysms develop when the wall of the aorta weakens, causing it to bulge and form a balloon-like projection. This leads to further stretching of the wall of the aorta and eventually the wall can rupture, leading to massive internal bleeding. The main risk factors for AAA include increasing age, high blood pressure, smoking and family history of the condition. The guidance recommends:

- Endovascular stent-grafts are recommended as a treatment option for patients with unruptured infra-renal (ie. located below the kidney) abdominal aortic aneurysms, for whom surgical intervention (open surgical repair or endovascular aneurysm repair) is considered appropriate.

- The decision on whether endovascular aneurysm repair is preferred over open surgical repair should be made jointly by the patient and their clinician after assessment of a number of factors including:

I. Aneurysm size and structure/shape
II. Patient age, general life expectancy and fitness for open surgery
III. The short and long term benefits and risks of the procedures including aneurysm-related mortality and operative mortality

- Endovascular aneurysm repair should only be performed in specialist centres by clinical teams experienced in the management of abdominal aortic aneurysms

- Endovascular aortic stent grafts are not recommended for patients with ruptured aneurysms except in the context of research.

Dr Gillian Leng, NICE deputy chief executive said: "The overall incidence of AAA has increased in recent years and is likely to increase further with the ageing of the general population. The independent Committee carefully considered the evidence and concluded that, where appropriate, endovascular stent grafts offered a good use of NHS resources for unruptured infra-renal abdominal aortic aneurysms."

About NICE

1. The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health.

2. NICE produces guidance in three areas of health:

- public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector

- health technologies - guidance on the use of new and existing medicines, treatments and procedures within the NHS

- clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

About the guidance

3. The AAA technology appraisal is available at http://www.nice.org.uk/TA167

4. A stent-graft is a metal tube (stent) covered with a fabric mesh (graft). It is inserted into a blood vessel at the top of the leg and moved to where the aneurysm is. The stent-graft strengthens the blood vessel around the aneurysm and stops it bursting. A stent - graft is called 'endovascular' when it is inserted into a blood vessel.

NICE

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