What is an indication for performing angiography prior to abdominal aortic aneurysm (AAA) repair?

Angiography prior to abdominal aortic aneurysm (AAA) repair is particularly indicated in patients with a history of claudication. Claudication suggests the presence of peripheral arterial disease (PAD), which may be significant in the context of AAA repair. Evaluating the vascular status through angiography can help surgeons understand the extent of vascular disease and plan for potential challenges during AAA repair. Additionally, understanding the vascular anatomy is essential to minimize complications during and after the surgical procedure. In patients with claudication, there may be underlying issues in the arterial supply that the surgeon needs to address or anticipate.

While other factors such as a history of myocardial infarction, uncontrolled hypertension, and renal insufficiency are important considerations in the overall surgical risk assessment, they do not specifically indicate the need for angiography before the procedure. Myocardial infarction is more related to cardiac risk, uncontrolled hypertension pertains to blood pressure management during surgery, and renal insufficiency is a concern for anesthesia and postoperative management. None of these directly necessitate angiography to evaluate the vascular anatomy for an AAA repair.