, Volume 84, Issue 6, pp 381-389
Date: 23 Feb 2013

Dilemmas, challenges and current debates in approaching the rupture of an abdominal aortic aneurysm

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We aim to give a conceptual description of the differences between open and endovascular repair (EVAR) of abdominal aortic aneurysms (AAAs) which represents a significant problem due to the risk of rupture and its high death rates. Additionally, we underline and discuss the current debates referring to each approach.


The MEDLINE/PubMed database was searched for publications with the medical subject heading “Ruptured abdominal aortic aneurysms (RAAA)” and keywords “EVAR” or “open repair” or “eEVAR” or ” randomized controlled trials“. The search was conducted both on the basis of the MESH tree and as a text search. We restricted our search to English publications up to July 2010.


A total of 243 studies were identified, 78 of which were eventually deemed relevant to this review.


Patients who are suitable for this method are high-risk patients with suitable anatomy, and patients with suitable anatomy who expressed a preference for the method. The selection of patients for eEVAR is heavily debated, as far as factors like haemodynamic instability, imaging procedures, logistic issues and anatomical suitability are concerned. The “freer” the indications are for its application, the likelier the procedure is to present problems or failures which can lead to the process becoming challenged and restrained.