Indications for open repair of AAA

Consider open AAA repair when EVAR is not applicable and comorbidities are not prohibitive, for patients with the following:

Asymptomatic AAA >5.5 cm diameter in men, >5.0 cm diameter in women*

Rapidly expanding AAA (>5 mm in 6 months)

Symptomatic AAA^¶ regardless of diameter; anatomy unsuited for EVAR

Infected AAA^Δ^¶^◊

Conversion after failed EVAR

The table shows general criteria for open repair of AAA. Please refer to UpToDate topics for a full discussion of the management of asymptomatic AAA and symptomatic and ruptured AAA.

AAA: abdominal aortic aneurysm; EVAR: endovascular aortic repair.
* In women, a smaller diameter may be more appropriate depending on the clinical circumstance.
¶ Saccular AAA may be more likely to become symptomatic compared with fusiform AAA of the same diameter.
Δ Primary AAA infection (ie, no prior graft) is overall uncommon. When a saccular AAA is identified, care should also be taken to rule out an infectious etiology.
◊ EVAR may be used as a temporizing measure, typically with interval open repair to remove the graft and provide definitive revascularization.

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Indications for open repair of AAA