{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T17:41:57Z","timestamp":1789926117425,"version":"4.0.1"},"reference-count":47,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,12,12]],"date-time":"2023-12-12T00:00:00Z","timestamp":1702339200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:p>Ruptured abdominal aortic aneurysms (rAAA) remain one of the most clinically challenging and technically complex emergencies in contemporary vascular surgery practice. Over the past 30 years, a variety of changes surrounding the treatment of rAAA have evolved including improvements in diagnosis, development of coordinated referral networks to transfer patients more efficiently to higher volume centers, deliberate de-escalation of pre-hospital resuscitation, modification of patient and procedure selection, implementation of clinical pathways, as well as enhanced awareness of certain high-impact postoperative complications. Despite these advances, current postoperative outcomes remain sobering since morbidity and mortality rates ranging from 25%-50% persist among modern published series. Some of the most impactful variation in rAAA management has been fostered by the rapid proliferation of endovascular repair (EVAR) along with service alignment at selected centers to improve timely revascularization. Indeed, clinical care pathways and emergency response networks are now increasingly utilized which has led to improved outcomes contemporaneously. Moreover, evolution in pre- and post-operative physiologic resuscitation has also contributed to observed improvements in rAAA outcomes. Due to different developments in care provision over time, the purpose of this review is to describe the modern management of rAAA, while providing historical perspectives on patient, procedure and systems-based practice elements that have evolved care delivery paradigms in this complex group of patients.<\/jats:p>","DOI":"10.3389\/fcvm.2023.1323465","type":"journal-article","created":{"date-parts":[[2023,12,12]],"date-time":"2023-12-12T00:41:53Z","timestamp":1702341713000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":23,"title":["Modern management of ruptured abdominal aortic aneurysm"],"prefix":"10.3389","volume":"10","author":[{"given":"Salvatore T.","family":"Scali","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David H.","family":"Stone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,12,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"191","DOI":"10.23736\/S0021-9509.21.11776-8","article-title":"A history of open thoracoabdominal aortic aneurysm repair: perspective from Houston","volume":"62","author":"Green","year":"2021","journal-title":"J Cardiovasc Surg (Torino)"},{"key":"B2","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1177\/175045890801800605","article-title":"The first ligation of the abdominal aorta","volume":"18","author":"Ellis","year":"2008","journal-title":"J Perioper Pract"},{"key":"B3","doi-asserted-by":"publisher","first-page":"89","DOI":"10.12945\/j.aorta.2013.13-004","article-title":"From ebers to evars: a historical perspective on aortic surgery","volume":"1","author":"Bobadilla","year":"2013","journal-title":"Aorta (Stamford)"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3390\/jcm12175530","article-title":"The management of ruptured abdominal aortic aneurysms: an ongoing challenge","volume":"12","author":"Troisi","year":"2023","journal-title":"J Clin Med"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1531","DOI":"10.1016\/S0140-6736(02)11522-4","article-title":"The multicentre aneurysm screening study (mass) into the effect of abdominal aortic aneurysm screening on mortality in men: a randomised controlled trial","volume":"360","author":"Ashton","year":"2002","journal-title":"Lancet"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1101","DOI":"10.1016\/j.jvs.2008.06.031","article-title":"National trends in the repair of ruptured abdominal aortic aneurysms","volume":"48","author":"Mureebe","year":"2008","journal-title":"J Vasc Surg"},{"key":"B7","doi-asserted-by":"publisher","first-page":"963","DOI":"10.1016\/S0140-6736(14)60109-4","article-title":"Mortality from ruptured abdominal aortic aneurysms: clinical lessons from a comparison of outcomes in England and the USA","volume":"383","author":"Karthikesalingam","year":"2014","journal-title":"Lancet"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1259","DOI":"10.1136\/bmj.38272.478438.55","article-title":"Population based randomised controlled trial on impact of screening on mortality from abdominal aortic aneurysm","volume":"329","author":"Norman","year":"2004","journal-title":"Br Med J"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3390\/ijerph15122805","article-title":"Risk factors for abdominal aortic aneurysm in population-based studies: a systematic review and meta-analysis","volume":"15","author":"Altobelli","year":"2018","journal-title":"Int J Environ Res Public Health"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1438","DOI":"10.1016\/j.jvs.2021.04.037","article-title":"Society for vascular surgery implementation of clinical practice guidelines for patients with an abdominal aortic aneurysm: postoperative surveillance after abdominal aortic aneurysm repair","volume":"74","author":"Rokosh","year":"2021","journal-title":"J Vasc Surg"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1161\/JAHA.116.004725","article-title":"Lifestyle and risk of screening-detected abdominal aortic aneurysm in men","volume":"6","author":"Stackelberg","year":"2017","journal-title":"J Am Heart Assoc"},{"key":"B12","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1016\/j.jvs.2017.10.044","article-title":"The society for vascular surgery practice guidelines on the care of patients with an abdominal aortic aneurysm","volume":"67","author":"Chaikof","year":"2018","journal-title":"J Vasc Surg"},{"key":"B13","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1016\/j.ejvs.2018.09.020","article-title":"Editor\u2019s choice - 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