SAIMSARA Journal

Machine Generated Science • ISSN 3054-3991

EVAR for Abdominal Aortic Aneurysm: Scoping Review with ☸️SAIMSARA.

Cardiac & Vascular Health icon

Cardiac & Vascular Health

Issue 1, Volume 1, 2026

DOI: 10.62487/saimsaraf864f6ac

Editorial note
• Last update: 2026-05-02 21:36:37
What is this paper about
EVAR saves lives early, especially in ruptured abdominal aortic aneurysm, but it is not a “fit-and-forget” repair. This review maps where EVAR is strongest, where open surgery remains more durable, and why anatomy, frailty, sex-specific morphology, endoleaks, and lifelong surveillance decide the real long-term outcome.
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Abstract: To provide a comprehensive synthesis of clinical outcomes, complication profiles, and prognostic factors associated with endovascular aneurysm repair (EVAR) in the treatment of abdominal aortic aneurysms across elective and emergency settings. The review utilises 3303 original studies with 15885052 total participants (topic deduplicated ΣN). Across the mapped evidence, EVAR emerges as the dominant perioperative strategy for abdominal aortic aneurysm, with elective 30-day mortality near 1.7% versus 4.7% for open surgical repair and ruptured-aneurysm mortality of 19.7–25% versus 35.8–49%, yet this early advantage attenuates over follow-up extending to 15 years because of higher reintervention burden and late secondary sac rupture. The topic synthesis indicates recurrent signals around hostile neck anatomy, female-specific morphology, type II endoleak natural history, frailty, and device-generation effects as the principal modifiers of durability, while complex fenestrated or branched repair, chimney techniques, and pre-emptive branch embolization expand anatomical reach at the cost of additional renal, contrast, and reintervention burdens. Diagnostic mapping supports a growing role for contrast-enhanced ultrasound and low-contrast or carbon dioxide imaging as radiation- and nephrotoxicity-sparing alternatives for surveillance, and pharmacological signals suggest statin exposure is associated with improved long-term survival. Clinically, these findings highlight individualized selection that integrates anatomical suitability, frailty, sex-specific morphology, and life expectancy, alongside protocolized ruptured-aneurysm pathways and lifelong imaging surveillance. The evidence remains heterogeneous and largely observational, particularly for octogenarian, nonagenarian, infective, inflammatory, and unfit-for-open-repair subgroups. Future research should prioritize long-term comparative trials of newer-generation endografts against open surgical repair in younger and anatomically complex patients, with parallel work clarifying anticoagulation effects on endoleaks, sex-tailored device design, and frailty-guided intervention thresholds.

Keywords: Endovascular aneurysm repair; Abdominal aortic aneurysm; Ruptured abdominal aortic aneurysm; Type 2 endoleak; Open surgical repair; Cost-effectiveness; Postoperative complications; Frailty; Chimney EVAR; Acute kidney injury

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Reference Index (247)