Innovations in abdominal aortic aneurysm repair: a comprehensive overview

Abstract

An abdominal aortic aneurysm (AAA) is a localized enlargement of the abdominal aorta to more than 50% of its normal diameter (NICE AAA guidelines [NG156]). An inner-to-inner aortic diameter of ≥3.0 cm is considered aneurysmal on ultrasound examination. Elective AAA repair is considered when the risk of rupture outweighs the risks of repair. The current diameter threshold for offering elective AAA repair is ≥5.5 cm in the UK (NICE AAA guidelines [NG156]). This article explores the surgical options for AAA repair, which encompass both open surgical repair (OSR) and less invasive endovascular aneurysm repair (EVAR). The selection of the appropriate treatment necessitates evaluation of patient health, fitness, aortic anatomy, and shared decision making. We describe the critical elements of OSR and EVAR, emphasizing the decision-making processes, the step-by-step procedures, and the importance of postoperative follow-up for optimal long-term outcomes. Additionally, the article delves into more complex AAA repairs, fenestrated and branched aortic stent grafts and open juxta-renal aortic aneurysm repair, providing insights into the latest advancements in this field.