The advent of endovascular stent-graft repair as the mainstay of AAA repair has changed this line of thinking.  Prior to endovascular stent-graft repair, most patients older than 75 were not recommended for surgery. With procedures done through small minimally invasive incision in the groins (avoiding an large abdominal incision), recovery is remarkably faster. Patients often are ambulating and eating normal diets within one post-op day. “Downtime” is significantly reduced, with full return to normal activity within days. Most importantly, perioperative morbidity and mortality of endovascular repaired are considerably reduced compared to open repair.

Given this new technology, our evaluation of patients for surgery is much more based on functional status (instead of absolute age cut-offs).  Much of previous age limits for open repair were based on the idea of preventing a likely rupture over the next five to ten years. With open surgery, the risk of surgery was significant, especially in patients with advanced age; the perioperative morbidity recovery times especially with advanced age was prohibitive. This risk generally outweighed the relatively lower risk of mortality from a rupture over those 5-10 years.

With new endovascular repair, the overriding principle is still the prevention of a rupture. However, now without the quality of life “penalty” of a major surgery (i.e. with significantly reduced perioperative morbidity and with much faster recovery times to full functionality), the emphasis can now focus on prevention of rupture in the immediate sense (with decreased focus on patient’s long term life expectancy). Patients can now have freedom from rupture with less overall concern of age. A patient’s functional status (patient’s activity level and comorbidities) plays a very important role, as do overall surgical considerations.