Consider open AAA repair when EVAR is not applicable and comorbidities are not prohibitive, for patients with the following:
Asymptomatic AAA >5.5 cm diameter in men, >5.0 cm diameter in women*
Rapidly expanding AAA (>5 mm in 6 months)
Symptomatic AAA¶ regardless of diameter; anatomy unsuited for EVAR
Infected AAAΔ¶◊
Conversion after failed EVAR
The table shows general criteria for open repair of AAA. Please refer to UpToDate topics for a full discussion of the management of asymptomatic AAA and symptomatic and ruptured AAA.
AAA: abdominal aortic aneurysm; EVAR: endovascular aortic repair. * In women, a smaller diameter may be more appropriate depending on the clinical circumstance. ¶ Saccular AAA may be more likely to become symptomatic compared with fusiform AAA of the same diameter. Δ Primary AAA infection (ie, no prior graft) is overall uncommon. When a saccular AAA is identified, care should also be taken to rule out an infectious etiology. ◊ EVAR may be used as a temporizing measure, typically with interval open repair to remove the graft and provide definitive revascularization.