Ruptured Abdominal Aortic Aneurysm

in Aortic Aneurysmal Disease

Applied

Type

Modification

Confidence

90%

Created

Apr 19, 2026

Evidence

1 source

Rationale

The existing citation ESVS for the claim that open repair remains essential for unsuitable anatomy or lack of endovascular capability is superseded by the ESVS 2024 Clinical Practice Guidelines (PMID 41801947), which covers the same recommendation. Per the stale guideline replacement instructions, ESVS has been replaced with ESVS for this claim. The key ESVS already exists in the chapter's citation list, so no new key is introduced. No other content changes are warranted as the article does not introduce new factual claims beyond what is already covered in the section.

Evidence

ESVS. Review of the European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Abdominal Aorto-Iliac Artery Aneurysms: what is new and prospects for development. 2026. PMID: 41801947. DOI: 10.33029/1027-6661-2024-30-2-131-136.
Verified source
PubMedDOI

Content Changes

* Epidemiology & outcomes: rAAA carries near-universal mortality without repair; contemporary 30-day mortality after repair is ~30–40% across series [@powell2014-improve].
* Guidelines: An endovascular aneurysm repair (EVAR)-first approach is recommended when anatomically feasible and resources are available [@svs2018]; open repair remains essential for unsuitable anatomy or lack of endovascular capability [@esvs2024-editors].[@esvs2024].
* Evidence: Randomized strategy trials (e.g., IMPROVE) found similar 30-day mortality between EVAR-first and open strategies overall [@powell2014-improve], validating CT-based triage and showing benefits in process measures (faster discharge home, cost) and in EVAR-capable centers [@improve2017]. Absolute mortality reductions should be interpreted with caution in the absence of center-specific data.
* Technical considerations: Prioritize local/regional anesthesia, percutaneous access, and rapid proximal seal for rEVAR; for open repair, expeditious clamp placement and hemorrhage control. Post-repair: aggressive hemodynamic optimization, renal protection, abdominal compartment syndrome (ACS) surveillance, and early imaging when feasible.

**Related:** For comprehensive management of ACS following rAAA repair, see [[Abdominal Compartment Syndrome (ACS)|Ch. 17]].
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