Abdominal Aortic Aneurysm Repair in Advanced Age/Elderly Patients

Abdominal aortic aneurysm (AAA) represents a significant vascular condition in the elderly, with therapeutic challenges due to the high prevalence of comorbidities and the complexity of choosing between endovascular repair (EVAR) and open surgery (OSR).Objective: To analyze the main factors that impact the results of AAA repair in elderly patients, addressing surgical techniques, associated risks, postoperative complications and impact on quality of life.Methodology: Bibliographic review, conducted in the PubMed database.After applying the inclusion and exclusion criteria, 21 articles published between 2021 and 2025 were selected for analysis.Results: The choice between EVAR and OSR should be individualized, considering the patient's frailty and comorbidities, such as hypertension and renal failure.EVAR has lower in-hospital mortality (<1% in octogenarians), shorter recovery time and lower perioperative risk, but greater need for reinterventions over time.OSR, on the other hand, despite the higher initial surgical risk, can offer greater durability of the repair.Patients who were less frail and taking statins showed better long-term clinical and functional outcomes.Final considerations: EVAR is a safer approach for the elderly, especially octogenarians, but the decision should be based on an individualized assessment that includes frailty, comorbidities and post-operative support.Standardization of indication criteria and the development of new therapeutic strategies are essential to optimize outcomes and reduce the need for re--interventions.