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Open surgical repair of abdominal aortic aneurysm

John F Eidt, MD
Section Editor
Joseph L Mills, Sr, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS


Replacement of the abdominal aorta for the repair of abdominal aortic aneurysm has been performed since it was first described in 1952 [1]. Prosthetic materials have since replaced the arterial homografts that were originally used and open surgical repair has proven to be a durable procedure [2]. Open repair of abdominal aortic aneurysm is performed under general anesthesia with appropriate monitoring of volume status and fluid administration and transfusion, as needed. Repair of the aorta is carried out in a systematic fashion that involves opening the aneurysm, removing thrombus and debris from within the aorta, suturing a graft into the aorta proximally, and distally at the aortic bifurcation or the iliac or femoral vessels, whichever is deemed appropriate.

The preoperative evaluation and preparation, operative technique and postoperative care and follow-up of patients undergoing AAA repair is reviewed here. General issues regarding management of AAA and the surgical and endovascular management of ruptured AAA are discussed elsewhere. (See "Management of asymptomatic abdominal aortic aneurysm" and "Management of symptomatic (non-ruptured) and ruptured abdominal aortic aneurysm" and "Surgical and endovascular repair of ruptured abdominal aortic aneurysm".)


The indications for repair of abdominal aortic aneurysm (AAA) are discussed in detail elsewhere and include symptomatic aneurysm of any size (eg, abdominal, back or flank pain, evidence of embolization, frank rupture), asymptomatic aneurysm ≥5.5 cm [3,4], rapidly expanding AAA, AAA associated with other arterial disease, infected AAA, and complications following endovascular repair necessitating early or late conversion to an open AAA repair [5]. The clinical evaluation and management of AAA are discussed separately. (See "Management of asymptomatic abdominal aortic aneurysm", section on 'Summary of indications for elective AAA repair' and "Management of symptomatic (non-ruptured) and ruptured abdominal aortic aneurysm", section on 'Approach to AAA associated with symptoms'.)

Contraindications — Open repair of abdominal aortic aneurysm is contraindicated in patients with a prohibitive risk for perioperative mortality and morbidity. These risk factors are discussed below. (See 'Medical risk assessment' below.)

Relative contraindications to open surgical repair of AAA in the era of endovascular aneurysm repair may include the following: hostile abdomen, obesity, major cardiac or pulmonary comorbidities, and limited life expectancy. (See "Management of asymptomatic abdominal aortic aneurysm", section on 'Open versus endovascular aneurysm repair' and "Management of symptomatic (non-ruptured) and ruptured abdominal aortic aneurysm".)


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Literature review current through: Sep 2016. | This topic last updated: Jul 11, 2016.
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