Anaesthesia for elective open abdominal aortic surgery

The prevalence of abdominal aortic aneurysm (AAA) and the number of patients undergoing aneurysm repair is increasing. The UK has worked hard to reduce its operative mortality rates for elective open AAA repair with the introduction of a quality improvement programme and death from ruptured aortic aneurysm through the national screening programme. Despite the increased prevalence of disease and intervention, the popularity of open repair is diminishing since the advent of endovascular repair (EVAR). The short-term benefits of EVAR when compared to open repair are evident, however, the long-term survival benefits have yet to be proven. The choice of technique for emergency AAA repair is contentious, with the more traditional approach of open repair being rapidly overtaken by endovascular options. In this article we 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.