Aortic

AAA is permanent focal dilatation of the abdominal aorta, conventionally ≥30 mm. Most are infrarenal and asymptomatic. Management is rupture risk versus treatment risk: symptoms, growth, diameter, sex, anatomy, fitness, life expectancy and patient preference. The high-yield UK issue is guideline divergence: NICE defaults to open repair when suitable, whereas ESVS 2024 is more EVAR-supportive for anatomically suitable patients after shared decision-making.

Standard infrarenal EVAR excludes an abdominal aortic aneurysm by creating a sealed route from healthy infrarenal aorta into both iliac arteries. Success depends on proximal and distal seal, component overlap, renal and pelvic perfusion, patent limbs and safe access closure. This is a trainee mental rehearsal for elective bifurcated infrarenal EVAR; the exact device IFU governs sizing and deployment.

Open AAA repair replaces the aneurysmal segment with a prosthetic graft sewn to healthy artery. The core sequence is control → exposure → heparin and clamp → open sac and control back-bleeding → proximal and distal reconstruction → flush and de-air → controlled reperfusion → prove organ and limb perfusion → cover the graft and close. This guide covers elective infrarenal transperitoneal repair.