Fairman AS, Chin AL, Jackson BM, et al. - Researchers evaluated the trends in the characteristics of and indications for open abdominal aortic aneurysm (AAA) repair over time through the experience at a tertiary care academic center. They retrospectively reviewed data from 628 patients (71.5% male; 88.2% white; mean age: 70.5 ± 9.4 years) who underwent open AAA repair (inclusive of type IV thoracoabdominal aortic aneurysms) from 2005 to 2018 at an academic institution. The mean aneurysm diameter was 6.2 ± 1.5 cm.  A retroperitoneal approach was favored in the majority of cases (82.5%). The proximal clamp sites were supraceliac (46.1%), suprarenal (29.1%), and infrarenal (24.8%); renal artery reimplantation was required in nearly a third of patients. An urgent repair was required in the majority of patients requiring postoperative hemodialysis (75%). An increase in complexity in aneurysm repair was identified over time, with the requirement for explantation among urgent repairs significantly on the rise. For long-term mortality, the independent predictive factors were urgency and clamp location, even after adjustment for age. Findings thereby highlight the changing landscape of open AAA repair in the current era.