Ruptured Abdominal Aortic Aneurysm
Type
ModificationConfidence
90%
Created
Apr 14, 2026
Evidence
1 source
Rationale
The existing citation [@wanhainen2019] supports the claim that open repair remains essential for unsuitable anatomy or lack of endovascular capability. The 2024 ESVS guidelines (esvs2024-editors) supersede this earlier guideline and cover the same recommendation. Per the stale guideline replacement instructions, the stale citation is replaced rather than co-cited. The citation key esvs2024-editors is already listed among existing chapter keys, confirming it is the correct superseding reference. No other substantive content changes are warranted as the remaining evidence and technical considerations are unaffected by this article.
Evidence
Content Changes
- Epidemiology & outcomes: rAAA carries near-universal mortality without repair; contemporary 30-day mortality after repair is ~30–40% across series (Powell 2014).
- Guidelines: An endovascular aneurysm repair (EVAR)-first approach is recommended when anatomically feasible and resources are available (Chaikof 2018)📄; open repair remains essential for unsuitable anatomy or lack of endovascular capability (ESVS 2024).
- Evidence: Randomized strategy trials (e.g., IMPROVE) found similar 30-day mortality between EVAR-first and open strategies overall (Powell 2014), validating CT-based triage and showing benefits in process measures (faster discharge home, cost) and in EVAR-capable centers (Powell 2017)📄. Absolute mortality reductions should be interpreted with caution in the absence of center-specific data.
- Technical considerations: Prioritize local/regional anesthesia, percutaneous access, and rapid proximal seal for rEVAR; for open repair, expeditious clamp placement and hemorrhage control. Post-repair: aggressive hemodynamic optimization, renal protection, abdominal compartment syndrome (ACS) surveillance, and early imaging when feasible.
Related: For comprehensive management of ACS following rAAA repair, see 17Ch. 17.
- Epidemiology & outcomes: rAAA carries near-universal mortality without repair; contemporary 30-day mortality after repair is ~30–40% across series (Powell 2014).
- Guidelines: An endovascular aneurysm repair (EVAR)-first approach is recommended when anatomically feasible and resources are available (Chaikof 2018)📄; open repair remains essential for unsuitable anatomy or lack of endovascular capability (Wanhainen 2019)📄.
- Evidence: Randomized strategy trials (e.g., IMPROVE) found similar 30-day mortality between EVAR-first and open strategies overall (Powell 2014), validating CT-based triage and showing benefits in process measures (faster discharge home, cost) and in EVAR-capable centers (Powell 2017)📄. Absolute mortality reductions should be interpreted with caution in the absence of center-specific data.
- Technical considerations: Prioritize local/regional anesthesia, percutaneous access, and rapid proximal seal for rEVAR; for open repair, expeditious clamp placement and hemorrhage control. Post-repair: aggressive hemodynamic optimization, renal protection, abdominal compartment syndrome surveillance, and early imaging when feasible.
Related: For comprehensive management of abdominal compartment syndrome (ACS) following rAAA repair, see 17Ch. 17.
- Epidemiology & outcomes: rAAA carries near-universal mortality without repair; contemporary 30-day mortality after repair is ~30–40% across series (Powell 2014).
- Guidelines: An endovascular aneurysm repair (EVAR)-first approach is recommended when anatomically feasible and resources are available (Chaikof 2018)📄; open repair remains essential for unsuitable anatomy or lack of endovascular capability (ESVS 2024).
- Evidence: Randomized strategy trials (e.g., IMPROVE) found similar 30-day mortality between EVAR-first and open strategies overall (Powell 2014), validating CT-based triage and showing benefits in process measures (faster discharge home, cost) and in EVAR-capable centers (Powell 2017)📄. Absolute mortality reductions should be interpreted with caution in the absence of center-specific data.
- Technical considerations: Prioritize local/regional anesthesia, percutaneous access, and rapid proximal seal for rEVAR; for open repair, expeditious clamp placement and hemorrhage control. Post-repair: aggressive hemodynamic optimization, renal protection, abdominal compartment syndrome (ACS) surveillance, and early imaging when feasible.
Related: For comprehensive management of ACS following rAAA repair, see 17Ch. 17.
Reviewer Notes
Approved after replacement-first stale-guideline regeneration review. Clean same-family replacement of stale guideline citation with the known 2024 ESVS AAA superseding guideline.