The Abdominal Aortic Aneurysm From Pathogenesis to Modern Treatment Approaches – Open Surgery Versus Evar

Introduction and Purpose: Abdominal aortic aneurysm (AAA) is a serious vascular condition with a high risk of rupture and associated mortality. It most commonly affects older males with cardiovascular risk factors such as smoking, hypertension, and atherosclerosis. With the advancement of surgical techniques, two primary treatment strategies have emerged: open aneurysm repair (OAR) and endovascular aneurysm repair (EVAR). This paper aims to review and compare both approaches in terms of clinical effectiveness, safety profile, indications, complications, and long-term outcomes, while also considering molecular, biomechanical, and economic aspects. Materials and Methods: A thorough analysis of contemporary clinical evidence was performed, emphasizing both surgical and endovascular treatment modalities' strengths, limitations, and clinical outcomes. The analysis also included pathophysiological mechanisms underlying AAA development. State of Knowledge: OAR remains the treatment of choice in younger patients and in cases with complex aneurysm anatomy, connective tissue disorders, infection, or unfavorable vascular morphology. Despite being more invasive, OAR offers long-term durability and lower rates of secondary interventions. EVAR, in contrast, is associated with lower perioperative mortality, shorter hospitalization, and faster recovery, but requires lifelong imaging surveillance and carries a higher risk of reintervention due to complications such as endoleaks or graft migration. Long-term survival appears comparable between both methods, though some studies suggest a potential advantage of OAR in certain subgroups. Ongoing research into fenestrated and branched endografts, microRNA modulation and epigenetic enzyme targeting may pave the way for more personalized and non-surgical treatment options. Conclusions: Both OAR and EVAR have specific indications and limitations, and the choice of therapy should be individualized based on patient characteristics, anatomy, and institutional expertise. Further multicenter, long-term studies are needed to evaluate overall survival, complication rates, cost-effectiveness, and quality of life in patients undergoing AAA repair.