In the Era of Endovascular Enthusiasm, is There a Role for Open Abdominal Aortic Aneurysm Repair in the Setting for Ruptured AAAs?

BACKGROUND: To investigate whether, in the current endovascular era, open surgery still plays a relevant and effective role in the management of ruptured abdominal aortic aneurysms (rAAAs). METHODS: The management of rAAA in the emergency setting has evolved significantly over recent years. The widespread adoption of endovascular repair has transformed treatment strategies for many vascular pathologies, showing outcomes comparable to those of open repair (OR). Based on the evidence from the past 2 decades, this article aims to highlight the continued role of open surgical repair, focusing on the main procedural differences between open and endovascular approaches in emergent situations. RESULTS: Open repair for rAAA remains a valid treatment option in selected cases, particularly when anatomical challenges or center-specific surgical expertize favor this approach. Conversely, endovascular repair has become the preferred strategy in standard cases, due to its reduced procedural time and feasibility even in emergency settings, often allowing rapid aortic control in life-threatening situations. CONCLUSION: Despite the advances and widespread adoption of endovascular techniques, OR for ruptured AAA continues to provide excellent outcomes in appropriately selected patients and specialized centers.