Repair of asymptomatic abdominal aortic aneurysms is recommended when the risk of rupture exceeds the risk of repair and is performed in patients with sufficient life expectancy to allow them to benefit from such a prophylactic procedure. Most elderly, or medically high risk patients, have insufficient life expectancy and are at higher risk of complications following endovascular repair to warrant intervention.
Sources:
EVAR Trial Participants. Endovascular aneurysm repair and outcome in patients unfit for open repair of abdominal aortic aneurysm (EVAR trial 2): randomised controlled trial. Lancet 2005; 365(9478):2187-92. PMID: 15978926.