What are the primary methods of abdominal aortic aneurysm (AAA) surgical repair?

Updated: Jan 08, 2019
  • Author: Saum A Rahimi, MD, FACS; Chief Editor: Vincent Lopez Rowe, MD  more...
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There are two primary methods of AAA repair, open repair and EVAR. Open AAA repair requires direct access to the aorta via an abdominal or retroperitoneal approach. It is well established as definitive treatment, having been in use for over 50 years.

Generally, EVAR is advocated for patients who are at increased risk with open repair, but until results from randomized controlled trials are available, patient preference is the strongest determinant in deciding between endovascular and open approaches. For EVAR to be considered, the following anatomic criteria should be met [24] :

  • Iliofemoral access vessels that will allow safe insertion and deployment of the device, adequate seal, and sufficient length to provide axial support for the graft
  • Infrarenal aortic neck of adequate length, limited angulation, and appropriate diameter

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