[Abdominal aortic aneurysm in frail elderly patients: obstacles for appropriate care]

The Dutch healthcare system is strained due to population aging, workforce shortages, and rising costs. The Integral Care Act introduced the concept of appropriate care, in which value-based choices are central. Frail elderly patients with an abdominal aortic aneurysm (AAA) have worse outcomes after surgery. Clear guidelines for this group are lacking, while appropriate care could provide benefits. A conservative approach by refraining from surgery, despite an indication for intervention, may be a realistic option aligned with the do no further harm principle. Two measures can support this choice: refraining from further increasing volume thresholds, as this may have counterproductive effects, and providing appropriate reimbursement for the complex preoperative assessment, shared decision-making process, and where needed the multidisciplinary involvement. These measures support vascular surgeons, patients, and caregivers to achieve genuine shared decision-making, ensuring a meaningful final stage of life for patients.