Choice of treatment for the patient with urgent AAA: practical tips

Since the first successful attempts of emergency endovascular aneurysm repair (eEVAR) for patients with ruptured AAAs in the mid 1990s, surgeons have had to decide whether to treat patients by conventional open surgery or by minimally invasive but technically more demanding eEVAR. To date, selection of patients for eEVAR is still heavily debated and factors like hemodynamic instability, fear of treatment delay for patient transfer or imaging procedures and logistic issues often lead to the exclusion of anatomically suitable patients from eEVAR. However, these adverse factors may be overcome by adherence to an appropriate (intention-to-treat) protocol employing the use of a hypotensive hemostatic approach, transfemoral aortic balloon occlusion technique (when needed), different types of devices and an appropriate plan to resolve logistic issues, leaving anatomic suitability as the single most important determinant of suitability for EVAR.