Surgery & Perioperative/Vascular

AAA repair (EVAR / open)

also: abdominal aortic aneurysm repair · EVAR

Overview

Repair of an abdominal aortic aneurysm — elective above the size/growth threshold, or emergency if ruptured.

Mechanism

Endovascular (EVAR — stent graft via femoral arteries) or open repair (graft). EVAR has lower early mortality but needs surveillance; open is more durable.

Indications

Elective: AAA ≥5.5 cm, or ≥4 cm growing >1 cm/year, or symptomatic
Emergency: rupture (or symptomatic/tender)

The agents

EVARendovascular stent graft

Lower peri-op mortality; endoleak risk → surveillance.

Open repair

More durable; higher upfront risk.

Adverse effects

Rupture if untreatedserious

EVAR endoleak / graft migrationcommon

Distal embolisation, renal impairmentcommon

Cautions & contraindications

AAA <5.5 cm and not growing/symptomaticall

Surveillance, not surgery (risk outweighs benefit).

Choosing it

Pulsatile expansile abdominal mass; or sudden severe abdominal/back pain with hypotension and collapse (rupture).

Source: NICE NG156 — AAA