随着主动脉瘤治疗的现代进步，为什么有必要进行开放性动脉瘤手术？
首先，当主动脉瘤大小超过5.5厘米且没有症状时，就需要进行治疗。然而，当患者出现腹部和背部疼痛且动脉瘤大于5.5厘米时，则需要紧急进行手术，最好是在同一家医院入院。
Second, over 99 % of the aneurysm can be treated by stenting but there are times that the aneurysm will require a customized (tailor-made) stent device and this will take up to 8 to 12 weeks to make. Hence, we cannot wait that long because the aneurysm would rupture.
Thirdly, when the anatomy is very complex, the risk of putting a stent inside a patient may not be lower than open surgery. Take an example a complex four-fenestrated stent (stent with 4 branches) used in the treatment of aortic aneurysm will have a 6 to 8 % 30-day mortality but open surgery will carry around a 5 % 30-day mortality risk.
最后，有非常好的科学数据表明，如果患者年轻并且可以生存超过 5 年，开放手术在干预较少的情况下效果更好，英国国家临床卓越研究所指南仍然建议开放手术作为一线治疗。
This gentleman had a successful open aortic aneurysm repair by Dr Tang and Dr Wong 6 months ago. He is now back playing golf. His midline abdominal wound has healed up nicely and he now won’t need any surveillance CT scans for his abdominal aortic repair compared to if he had an endovascular stent repair which would need lifelong surveillance.
