Perioperative Advances in Repair of Abdominal Aortic Aneurysm: A Narrative Review of Strategies to Enhance Outcomes and Reduce Complications

Despite ongoing advancements in abdominal aortic aneurysm (AAA) repair, perioperative complications remain a major concern. This narrative review offers a novel analysis of emerging perioperative strategies, uniquely integrating recent guideline updates with evolving innovations such as AI-driven risk models, frailty and sarcopenia assessment, and personalized hemodynamic management. Unlike previous reviews, this article bridges evidence-based practices with real-world implementation challenges, highlighting barriers to guideline adherence, especially in low-resource settings. The review evaluates the latest developments in anesthetic approaches, fluid and transfusion protocols, Enhanced Recovery After Surgery (ERAS) programs, and infection control measures, with a strong emphasis on tailored pathways for both open surgical repair (OPS) and endovascular aneurysm repair (EVAR). Long-term surveillance protocols and antimicrobial graft technologies are explored as key future directions. By connecting recent literature with practical, patient-centered applications, this work provides a forward-looking roadmap for optimizing AAA care across diverse clinical environments. Its novelty lies in presenting a comprehensive, multidisciplinary framework that incorporates precision medicine and implementation science to advance perioperative vascular surgery outcomes.