Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ Symptomatic or ruptured abdominal aortic aneurysm (AAA) of any size.Asymptomatic AAA ≥ 5.5 cm or > 0.8-cm growth in 12 months. +++ Absolute ++ None. +++ Relative ++ Malignancy with limited life expectancy.Prohibitive medical comorbidities. ++ Infrarenal AAA may be treated by open or endovascular repair.Perioperative mortality: Open repair: 2–5%.Endovascular repair: 1.2–1.6%.Repair of ruptured AAA: 50–75%. +++ Expected Benefits ++ Exclusion of the aneurysm wall from the systemic circulation and associated pressure, thereby preventing its rupture. +++ Potential Risks +++ Open Repair ++ The established treatment option for AAA for > 50 years. Associated with excellent long-term outcomes and fewer subsequent aneurysm-related procedures than endovascular repair.Limited by comorbidities.Can treat all aneurysms with no anatomic restraints.Involves longer hospital and ICU stays, results in more postoperative pain, and is associated with a higher 30-day mortality rate than endovascular repair.Complications include but are not limited to: Surgical site infections and incisional hernias.Myocardial infarction.Renal or respiratory failure.Retrograde ejaculation.Colonic ischemia.Embolization of clot to the legs. +++ Endovascular Repair ++ Well established for patients who are not surgical candidates and increasingly being used for all anatomically favorable aneurysms. Has specific anatomic requirements.Rate of aneurysm-related reintervention is higher than for open repair.Patients require lifelong follow-up with serial imaging.Is associated with a lower 30-day mortality rate than open repair.Complications following endovascular repair are similar to those for open repair, excluding retrograde ejaculation and incisional hernia. In addition, approximately 15% of patients treated with an endovascular approach will need at least one additional procedure to better seal the aneurysm from an endoleak or to fix a complication (eg, graft migration, stent fracture, graft material fatigue). +++ Open Repair ++ Vascular surgery instrument tray.Bookwalter or Omni retractor for abdominal exposure.Graft material (Dacron or polytetrafluoroethylene [PTFE] of various sizes, 12–36 mm). +++ Endovascular Repair ++ Vascular surgery instrument tray.Sterile angiographic capabilities with a full compliment of catheters and wires. A portable C-arm may be used, but a fixed fluoroscopic unit gives better images.The procedure should be done in a room with operative capabilities (eg, suction, electrocautery, good lighting, etc).An angiogram table that permits fluoroscopic imaging of the abdomen is required. ++ The arterial anatomy needs to be defined clearly. CT angiogram or MR angiogram may provide sufficient detail for operative planning.Preoperative stratification with a full history and physical examination is required. Eagle criteria or another cardiac risk stratification algorithm can be used to calculate the patient's perioperative risk for coronary events and need for further workup.All patients should receive optimal medical therapy in the perioperative period, including: β-Blockers.Statin therapy, with a goal low-density lipoprotein ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.