[Abdominal aortic aneurysms: diagnosis, risk stratification and treatment strategies]

Abdominal aortic aneurysm is defined as a focal aortic dilation ≥3.0 cm in maximum diameter, with rupture-associated mortality approaching 80%. Anatomical classification identifies infrarenal (80%), juxtarenal, pararenal and suprarenal aneurysms. Operative thresholds are 5.5 cm in men and 5.0 cm in women. Endovascular aortic repair (EVAR) provides an early survival benefit, with 30-day mortality of 1.8% vs 4.3% for open repair in the EVAR-1 trial, and substantially comparable long-term outcomes up to 15 years of follow-up, at the cost of a 15-20% reintervention burden and the need for lifelong imaging surveillance. Accordingly, the 2024 European Society for Vascular Surgery guidelines consider EVAR as the preferred treatment in most patients with favorable anatomy, reserving open repair for young patients with long life expectancy, unfavorable anatomy and specific conditions such as connective tissue disease, inflammatory aneurysms, graft infection and failed previous endovascular repair. Treatment selection should be based on the integrated assessment of individual operative risk, aortic anatomy and life expectancy.