Pioneering techniques in abdominal aortic surgery and endovascular aortic repair

The history and evolution of abdominal aortic aneurysm repair highlights the wider evolution of surgery from traditional open operative techniques to modern minimally invasive procedures. From their first recording in ancient Egypt, through surgical techniques such as aortic ligation, polyethylene wrapping, and external compression, and to the work of Astley Cooper and Rudolph Matas pioneering modern day open surgical repair, abdominal aortic aneurysm treatment remains a highly debated area. The introduction of endovascular techniques by Parodi provided the footing for the most significant recent step forward in vascular surgery however; randomized controlled trials comparing open and endovascular techniques suggest that a minimally invasive approach may not confer any long term survival advantage. Endovascular surgery is quickly evolving to overcome the problems placed by more challenging aortic anatomy with results from fenestrated endovascular aortic repair and endovascular aneurysm sealing looking promising however, prevention remains better than cure. The future of aneurysm treatment should involve public health strategies targeting smoking and other common cardiovascular risk factors to reduce the incidence of AAA as well as the concomitant risk of rupture.