Emergency Management and Surgical Repair of Abdominal Aortic Aneurysm: Comparing Open and Endovascular Approaches, Clinical Outcomes, and Survival Benefits

Background: Abdominal aortic aneurysms (AAAs) represent a critical vascular condition with high mortality if ruptured. While prevalence has declined due to reduced smoking rates, AAAs remain a leading cause of death in older adults, particularly men. Timely intervention is essential, with two primary repair strategies: open surgical repair (OSR) and endovascular aneurysm repair (EVAR). This review compares OSR and EVAR in terms of clinical outcomes, survival benefits, and complications to guide evidence-based management. Methods: A comprehensive analysis of peer-reviewed studies, clinical guidelines, and surgical outcomes was conducted, focusing on indications, contraindications, procedural techniques, and long-term surveillance. Results: Elective repair is recommended for AAAs ≥5.5 cm in men and ≥5.0 cm in women. EVAR demonstrates superior short-term outcomes, with lower perioperative mortality (1–2% vs. 3–5% for OSR) and reduced complications (e.g., pulmonary, cardiac). However, EVAR requires lifelong surveillance due to endoleak (10–20%) and migration risks. OSR, though more invasive, offers durable repair with fewer long-term reinterventions. Ruptured AAAs have >80% mortality; emergency EVAR, when feasible, improves survival over OSR. Conclusion: EVAR is preferred for anatomically suitable patients, while OSR remains viable for complex anatomy or younger patients. Multidisciplinary care, patient selection, and postoperative surveillance are critical for optimizing outcomes. Future research should focus on stent-graft durability and personalized risk stratification.