Endovascular Treatment versus Open Repair for Abdominal Aortic Aneurysms: The Influence of Fitness in Decision Making.

Two methods of repair are currently available for an abdominal aortic aneurysm (AAA), open aneurysm repair and endovascular aneurysm repair (EVAR). The decision making depends on the balance of risks and benefits. The treating physician must take into account the patient's life expectancy, the patient's fitness, the anatomic suitability that makes endovascular repair possible, and finally the patient's preference. The patient's fitness is an important variable predicting the outcome of AAA surgical reconstruction. The hypothesis is that the impact of risk factors upon perioperative mortality might differ between patients undergoing open repair and endovascular repair. The purpose of this review article is to investigate whether fitter patients with a large AAA benefit more from having endovascular rather than open repair. According to the available data, there is emerging evidence that patients at high medical risk for open repair may benefit from EVAR while in low risk patients with suitable anatomy for EVAR, both techniques have similar effects. There is rising evidence that a patient with ruptured AAA would benefit more from an endovascular procedure if eligible, and thus fitness in such emergencies is not the first priority but anatomical suitability for EVAR.