Endovascular abdominal aortic aneurysm repair

It is not a surprise that overall patient satisfaction is quite high given the rapidity of recovery of EVAR versus conventional repair; however, patients and families can underestimate the importance, and intrusion, of lifelong surveillance after EVAR. Nonetheless, EVAR has been enthusiastically accepted by many patients and physicians alike as a viable alternative to standard open repair of the AAA. EVAR also presents a challenge for the anesthesiologist, because it is often carried out on patients who might be too sick for open repair. The less invasive nature of the procedure seems particularly well-suited and advantageous in patients with AAA who were previously deemed to be too "high risk" on the basis of comorbidity or prior abdominal surgeries. EVAR could also be beneficial in patients with other unusual technical problems such as paraanastomotic pseudoaneurysms, previous aortic procedures, or prior renal transplantations. In time, technologic advances could expand the application of EVAR to include more complex aneurysms that involve aortic branches such as pararenal or thoracoabdominal aneurysms. Also, smaller delivery systems could eventually allow total percutaneous access for implantation and obviate the need for surgical exposure of the femoral vessels. For now, the current results and strategies of EVAR are competitive enough that surgeons have an obligation to at least offer the possibility of endoluminal repair, inform the patient of the advantages and limitations as best we know, and then let the patient determine which road they want to travel. For vascular surgeons and vascular anesthesiologists who care for patients undergoing endovascular aneurysm repair, as Yogi Berra once said, "The future ain't what it used to be".