Treatment

• Patients with any symptoms: immediate vascular surgery consult

  • Suspected or known rupture (regardless of patient stability) : emergency repair within 90 minutes (see “Ruptured AAA”)

  • Patients with signs or symptoms of impending rupture : urgent aneurysm repair, ideally within normal working hours, as this is associated with better outcomes

    • Maintain BP strictly within normal parameters.

    • Consult anesthesia.

• Asymptomatic patients: elective aneurysm repair or aneurysm surveillance

• All patients: reduction of cardiovascular risk factors [1]

  • Appropriate medical management of other atherosclerotic risk factors (e.g., hypertension, diabetes, hyperlipidemia)

  • Smoking cessation

Consult vascular surgery and the ICU about any patients with a symptomatic AAA.

• Emergency repair: unstable patients

• Urgent repair: impending rupture or leaking AAA

• Elective repair

  • Fusiform aneurysm with maximum diameter ≥ 5.5 cm and low or acceptable surgical risk

  • Small fusiform aneurysm expanding ≥ 1 cm per year

  • Saccular aneurysm [1]

  • Aneurysm with maximum diameter 5.0–5.4 cm in women

  • Small aneurysm (4.0–5.4 cm) in patients requiring chemotherapy, radiotherapy, solid organ transplantation: individual approach

• Endovascular aneurysm repair (EVAR)

  • Indications: minimally invasive procedure that is preferred over open surgical repair for most aneurysms, especially in patients with a high operative risk

  • Procedure: Under fluoroscopic guidance, an expandable stent graft is placed via the femoral or iliac arteries intraluminally at the site of the aneurysm.

• Open surgical repair (OSR)

  • Indications

    • Mycotic aneurysm or infected graft

    • Persistent endoleak and aneurysm sac growth following EVAR

    • Anatomical contraindications for EVAR

  • Procedure: A laparotomy is performed and the dilated segment of the aorta is replaced with a tube graft or Y-prosthesis (bifurcated synthetic stent graft).

• Small (< 5.5 cm), asymptomatic AAA can typically be observed with interval surveillance ultrasound. [15]

  • To identify the expansion rate and thus decrease the risk of rupture

  • Frequency depends on the size of the aneurysm.