Surgical management of abdominal aortic aneurysms: a lost art?

Endovascular repair of abdominal aneurysms has become the dominant treatment modality for infrarenal aneurysms. Initial reports showed a constant number of open repairs although there was a shift toward complicated juxtra-renal aneurysms. In the past several years, more aggressive endoluminal approaches and the introduction of fenestrated grafts have appeared to dilute the open aneurysm operating experience. Coupled with work hours restrictions and shorter training paradigms, opportunities for training residents in open repair of abdominal aneurysms are decreasing. We envision that future treatment of complicated aortic aneurysms will likely entail advanced fellowship training in open repair and referral of complicated abdominal aneurysms to tertiary care centers.