Aortic aneurysm repair aims to exclude a pathologically dilated aortic segment from high-pressure systemic blood circulation, eliminating the risk of lethal rupture. Positioned within cardiovascular and vascular surgery, repair strategies include open surgical repair (OSR) and minimally invasive endovascular aneurysm repair (EVAR for abdominal aneurysms; TEVAR for thoracic aneurysms). Technique selection relies on anatomical feasibility, patient physiological reserve, emergency status, and established clinical practice guidelines from major international vascular societies.

Pre-operative preparation requires computed tomography angiography (CTA) mapping of vessel anatomy. For Open Surgical Repair (OSR), under general anesthesia, a midline abdominal or retroperitoneal incision (or thoracotomy/sternotomy for thoracic repair) is performed. The surgeon clamps the aorta above and below the aneurysm to halt blood flow, opens the sac, and sutures a woven polyester (Dacron) or expanded polytetrafluoroethylene (ePTFE) synthetic graft into healthy vessel segments. The native aneurysm wall is wrapped around the graft for protection, and the incision is closed in layers. For Endovascular Aneurysm Repair (EVAR/TEVAR), under general, regional, or local anesthesia, small incisions or percutaneous punctures are made in both groins to access the femoral arteries. Under fluoroscopic X-ray guidance, flexible catheters deliver collapsed stent-grafts through the femoral arteries into the aortic aneurysm. The self-expanding or balloon-expandable components are deployed and expanded against healthy proximal and distal aortic walls (landing zones) to form a fluid-tight seal. Angiography confirms complete exclusion of the aneurysm sac without endoleak. Catheters are removed, and groin access sites are sutured or closed with vascular closure devices.

Aortic aneurysm repair successfully eliminates the risk of aortic rupture, a condition carrying an overall mortality rate exceeding 80%. Endovascular techniques provide reduced early 30-day mortality, lower blood loss, shorter intensive care unit and total hospital stays, and quicker recovery to independent baseline mobility compared to open surgery. Conversely, open surgical repair demonstrates long-term structural durability, extremely low rates of late graft failure, and minimal requirement for repeat secondary interventions or frequent follow-up imaging.

Recovery timeline depends directly on the surgical approach utilized. Endovascular repair requires a short hospital stay of 1 to 3 days, with most patients resuming light non-strenuous daily activities within 1 to 2 weeks. Open surgical repair entails 5 to 10 days of hospitalization, including 1 to 2 days in an intensive care setting, followed by 6 to 12 weeks of restricted physical activity to allow complete abdominal or thoracic wound healing and systemic physical restoration.

Aortic aneurysm repair treats localized dilations of the main arterial trunk of the human body, including abdominal aortic aneurysms (AAA), thoracic aortic aneurysms (TAA), and complex thoracoabdominal aortic aneurysms (TAAA). It addresses asymptomatic aneurysms that reach intervention size thresholds, rapidly expanding vessels, symptomatic non-ruptured aneurysms, saccular dilations, and acutely ruptured aortic wall segments.

Pre-procedural management involves full cardiac evaluation (electrocardiogram, echocardiogram, stress testing if indicated), renal function assessment, complete blood count, and cross-sectional computed tomography angiography (CTA) with thin-slice reconstruction. Patients must optimize medical therapy, including antiplatelet drugs, statins, and strict blood pressure control using beta-blockers or ACE inhibitors. Smoking cessation is mandatory prior to elective surgery. Antiplatelet medications or anticoagulants may require structured perioperative adjustment under specialist direction. Fasting guidelines require no solid food for 6 to 8 hours prior to anesthesia. Pre-operative skin cleansing and prophylactic intravenous antibiotics are administered immediately before skin incision.

Early perioperative complications include myocardial infarction, acute kidney injury (renal failure), limb ischemia, graft infection, deep vein thrombosis, pulmonary embolism, and death. Open repair carries higher short-term risks of intraoperative hemorrhage, respiratory failure, prolonged ileus, incisional hernia, and ischemic colitis. Endovascular repair carries risks of arterial access site hematoma, femoral artery dissection, device migration, structural stent fracture, and endoleak (persistent blood flow into the aneurysm sac outside the graft), which may necessitate secondary catheter interventions. Long-term risks include graft infection, aortoenteric fistula formation, and distal embolization.

The patient journey begins with cross-sectional imaging (computed tomography angiography) to evaluate aneurysm anatomy and establish eligibility for open or endovascular intervention. Following pre-operative cardiac and pulmonary clearance, the patient undergoes surgery under general, regional, or local anesthesia. Post-operative management includes intensive care or high-dependency unit monitoring, early mobilization, pain control, and strict blood pressure regulation. Patients recovering from endovascular repair undergo lifelong imaging surveillance to detect potential endoleaks or graft migration, whereas open repair patients follow a structured post-operative functional recovery schedule.