Which Patients Can Be Treated Medically, and Who Needs Surgical Intervention?

  • Brit Long
  • Alex Koyfman


Ruptured abdominal aortic aneurysm (AAA) is associated with nearly 100% mortality when left untreated. If a patient presents with an AAA rupture, emergent surgery is required. Patients with symptoms from an unruptured AAA require urgent surgery. Patients with an AAA > 5.5 cm, peripheral artery disease, peripheral arterial aneurysm, or rapid expansion of AAA should undergo elective repair. Surgical options include open repair and endovascular repair. Patients who do not meet criteria for repair should receive counseling on risk factor modification, including tobacco cessation, exercise, blood pressure and cholesterol management, and antiplatelet therapy.


Abdominal aortic aneurysm Surgical Medical Open repair Endovascular repair 


  1. 1.
    Bown MJ, Sutton AJ, Bell PR, Sayers RD. A meta-analysis of 50 years of ruptured abdominal aortic aneurysm repair. Br J Surg. 2002;89:714.CrossRefGoogle Scholar
  2. 2.
    Hoornweg LL, Storm-Versloot MN, Ubbink DT, et al. Meta analysis on mortality of ruptured abdominal aortic aneurysms. Eur J Vasc Endovasc Surg. 2008;35:558.CrossRefGoogle Scholar
  3. 3.
    Johnston KW, Rutherford RB, Tilson MD, et al. Suggested standards for reporting on arterial aneurysms. Subcommittee on Reporting Standards for Arterial Aneurysms, Ad Hoc Committee on Reporting Standards, Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery. J Vasc Surg. 1991;13:452.CrossRefGoogle Scholar
  4. 4.
    Hirsch AT, Haskal ZJ, Hertzer NR, et al. ACC/AHA 2005 practice guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (writing committee to develop guidelines for the management of patients with peripheral arterial disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. Circulation. 2006;113:e463.CrossRefGoogle Scholar
  5. 5.
    Chaikof EL, Brewster DC, Dalman RL, et al. SVS practice guidelines for the care of patients with an abdominal aortic aneurysm: executive summary. J Vasc Surg. 2009;50:880.CrossRefGoogle Scholar
  6. 6.
    Golledge J, Norman PE. Current status of medical management of abdominal aortic aneurysm. Atherosclerosis. 2011;217:57–63.CrossRefGoogle Scholar
  7. 7.
    Mortality results for randomised controlled trial of early elective surgery or ultrasonographic surveillance for small abdominal aortic aneurysms. The UK small aneurysm trial participants. Lancet. 1998;352(9141):1649–55.Google Scholar
  8. 8.
    Lo RC, Lu B, Fokkema MT, et al. Relative importance of aneurysm diameter and body size for predicting abdominal aortic aneurysm rupture in men and women. J Vasc Surg. 2014;59:1209.CrossRefGoogle Scholar
  9. 9.
    Baxter BT, Terrin MC, Dalman RL. Medical management of small abdominal aortic aneurysms. Circulation. 2008;117:1883.CrossRefGoogle Scholar
  10. 10.
    Chagpar RB, Harris JR, Lawlor DK, et al. Early mortality following endovascular versus open repair of ruptured abdominal aortic aneurysms. Vasc Endovasc Surg. 2010;44:645.CrossRefGoogle Scholar
  11. 11.
    Paravastu SC, Jayarajasingam R, Cottam R, et al. Endovascular repair of abdominal aortic aneurysm. Cochrane Database Syst Rev. 2014;1:CD004178.Google Scholar
  12. 12.
    Lederle FA, Johnson GR, Wilson SE, et al. The aneurysm detection and management study screening program: validation cohort and final results. Aneurysm detection and management veterans affairs cooperative study investigators. Arch Intern Med. 2000;160:1425.CrossRefGoogle Scholar
  13. 13.
    Prinssen M, Verhoeven EL, Buth J, et al. A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med. 2004;351:1607.CrossRefGoogle Scholar
  14. 14.
    EVAR trial participants. Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): randomised controlled trial. Lancet. 2005;365:2179.CrossRefGoogle Scholar
  15. 15.
    Becquemin JP, Pillet JC, Lescalie F, et al. A randomized controlled trial of endovascular aneurysm repair versus open surgery for abdominal aortic aneurysms in low- to moderate-risk patients. J Vasc Surg. 2011;53:1167.CrossRefGoogle Scholar
  16. 16.
    Lederle FA, Freischlag JA, Kyriakides TC, et al. Long-term comparison of endovascular and open repair of abdominal aortic aneurysm. N Engl J Med. 2012;367:1988.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Brit Long
    • 1
  • Alex Koyfman
    • 2
  1. 1.Brooke Army Medical Center, Department of Emergency Medicine, Fort Sam HoustonSan AntonioUSA
  2. 2.The University of Texas Southwestern Medical Center, Department of Emergency MedicineDallasUSA

Personalised recommendations