Zettervall SL, et al. - Researchers here evaluated the effect of liver disease on outcomes after endovascular repair of aortic aneurysms. The National Surgical Quality Improvement Program from 2005 to 2016 yielded data of endovascular aneurysm repairs (EVARs) in 18,484 patients; these included 2,286 with liver fibrosis and 16,198 without. Outcomes revealed a significant increase in mortality and major morbidity after EVAR in the presence of liver fibrosis. The utility of the aspartate transaminase to platelet ratio index and MELD score for preoperative risk stratification was suggested. Furthermore, among patients with MELD scores > 10, current 30-day morbidity and mortality rates exceed 5%, which is higher than the annual rupture risk for aneurysms < 6 cm. Hence, an increased size threshold of > 6 cm may be warranted before EVAR in liver fibrosis cases.