ABSTRACT
In the USA, an estimated 17,000 deaths are attributed annually to abdominal aortic aneurysms (AAAs). Screening programs, using abdominal ultrasound (US), in Europe and the USA have been useful in detecting patients with AAAs. The outcomes of elective repair, whether open or endovascular, are always more favorable than waiting for the AAA to rupture. Several randomized trials comparing elective endovascular aneurysm repair (EVAR) to open surgical repair have shown improved outcomes, especially in frail patients. This chapter describes the preoperative planning and intraoperative technique of EVAR for ruptured AAAs. During the preoperative period, permissive hypotension is a good option to help maintain any temporary seal following AAA rupture. Skin preparation from the chest to the thighs (nipples to knees) as with any open AAA repair is essential. To ensure the ideal outcomes for patients with ruptured AAAs, a multidisciplinary and coordinated approach needs to be adopted.
