These allow the most effective decision-making and treatment of these patients in what are often confusing and stressful circumstances [6, 7]. They are also important to facilitate education in and recognition of RAAAs by generalists, emergency room personnel, and others to enable early diagnosis and mobilization of the specialized caregivers best trained to optimize treatment.

Fluid resuscitation should be restricted even if the patient becomes hypotensive. Experience has shown that systolic arterial pressures of 50–70 mmHg are well tolerated for short periods and limit internal bleeding and its associated loss of platelets and clotting factors [2, 3, 7, 11]. Whether or not pharmacological lowering of blood pressure is beneficial remains to be conclusively shown [3, 7].

EVAR procedures are optimally performed in a site equipped for excellent fluoroscopic imaging and open surgery since some patients will require OR or open adjuncts to their EVAR.

The latter should be obtained percutaneously under local anesthesia. This permits arteriography to define aortic and arterial anatomy, facilitates large sheath and supraceliac balloon placement if needed, and prevents circulatory collapse caused by the induction of general anesthesia. Whether general anesthesia is used later to eliminate motion and improve fluoroscopic imaging to permit precise graft deployment remains controversial. One group has successfully used local anesthesia supplemented by sedation throughout as an alternative [1, 3, 7].