Objective: To evaluate and compare the effectiveness and clinical outcomes of abdominal aortic aneurysm treatments.
Methods: The medical records of all patients who underwent elective open or endovascular repair of nonruptured infra-renal abdominal aortic aneurysm from January 2001 to April 2009 were retrospectively reviewed. The assessed outcomes were all-cause mortality, aneurysm-related mortality, incidence of perioperative complications and reinterventions. Patient demographics and procedure characteristics were also analysed.
Results: One hundred and eighty four consecutive patients were included: 107 ( 58 % ) had open surgery and 77 ( 42 % ) had endovascular repair ( EVAR ). Medical complications were more frequent after open surgery ( 24 % vs 10 %; p=0.025 ). There was no perioperative mortality in the EVAR group, whereas in open surgery 9 deaths occurred ( 8.4 % in-hospital mortality; p=0.011 ). At 7 years, all cause mortality was similar in the two groups ( 27 vs 30 %; p=0.34 ). There was, however, a persistent difference in aneurysm-related mortality ( Kaplan-Meier estimates were 9.5 % in the open repair group and 1.5 % in the EVAR group; p=0.023 ). Reintervention rates for EVAR were not higher than those for open surgery ( at 5 years, 21.2 % vs 21.4 %; p=0.70 ).
Conclusions: In our institution, EVAR is associated with lower early mortality and morbidity compared to open repair. Despite equivalent late overall survival, endoluminal repair offers an aneurysm-related mortality 6 times inferior to open repair. The need for reintervention was similar after EVAR or open surgery. In this study setting, our findings support endovascular management of large AAAs, even in patients fit for open repair.