Anaesthesia for open abdominal aortic surgery

The prevalence of abdominal aortic aneurysm (AAA) has declined in recent years and according to the annual National Vascular Registry reports (2019–23) the number of patients undergoing aneurysm repair has been steadily decreasing over the last 5 years. The UK has worked tirelessly to reduce its operative mortality rates for elective open AAA repair with the introduction of a quality improvement pro-gramme. Reducing death from ruptured aortic aneurysm has been the focus of the national screening programme. The short-term benefits of endovascular aneurysm repair (EVAR) when compared to open repair are well described, however, the long-term survival benefits, freedom form re-intervention and cost effectiveness of EVAR have been demonstrated to be dominated by open surgery. That is that people with intact AAA should be offered open surgery if medically suitable. The choice of technique for emergency AAA repair is less contentious, with the more traditional approach of open repair being rapidly overtaken by endovascular options in those who are anatomically suitable for EVAR. Technical analysis by the National Institute for Health and Care Excellence has consistently reported favourable outcomes with EVAR in the emergency setting and that it is a cost-effective treatment. In this article we provide an overview of the evidence supporting the different treatment options, outline current approaches to risk stratification, describe the key physiological changes that occur during open repair and describe an overview of the approach to perioperative management.