The National Institute for Health and Clinical Excellence (NICE) has 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.

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.”