The management of ruptured infrarenal abdominal aortic aneurysms

Infrarenal abdominal aortic aneurysm (AAA) rupture occurs as a sudden, unheralded event that is lethal in up to 90% of patients. Many patients who present with ruptured AAAs often have no prior knowledge of the aneurysm, highlighting the need for increased screening of high-risk populations, particularly older males with a history of tobacco use or family history of AAA. Conventional treatment of ruptured AAAs has been open surgical repair. Despite advances in anesthesia and perioperative care, mortality rates for the conventional open surgical repair of ruptured AAAs range from 23-69%. Complications following open repair may include respiratory failure, renal insufficiency, sepsis, and myocardial infarction. Endovascular AAA repair offers a less invasive means of treating ruptured AAAs resulting in less hemodynamic stress on the patient. Multiple studies have demonstrated lower complication and mortality rates following endovascular AAA repair compared to open repair for the treatment of ruptured AAAs. This study reviews techniques and outcomes following both conventional open repair and endovascular repair of ruptured AAAs.