Comparison of open and endovascular treatment of infrarenal abdominal aortic aneurysms over 10 years-factors influencing the surgical method.

backgroundEndovascular aortic repair (EVAR) has become the predominant treatment for infrarenal abdominal aortic aneurysms (AAA). However, open surgical reconstruction (open aortic repair, OAR) of the infrarenal aorta has not lost its importance. While EVAR appears to be superior in the short and medium term, there is no difference between OAR and EVAR in the long term.

objectiveA retrospective study comparing OAR and EVAR was performed with the aim of identifying perioperative factors influencing the choice of the specific surgical procedure.

methodsOver a defined period of time, demographic data, cohort-associated data, aneurysm-derived factors, and treatment-related parameters were analyzed in a systematic clinical, single-center observational study comparing treatment procedures for AAA (for vascular surgery quality assurance and to contribute to the research in vascular medicine and clinical care).

resultsThe study population consisted of 324 consecutive patients who had undergone elective surgery for an infrarenal AAA from January 1, 2006, to August 29, 2016, using either EVAR or OAR (sex ratio 90.4% males and 9.6% females; mean age 71.1 years). There were no significant differences between the groups in terms of age and gender distributions. Interestingly, half of the patients were not treated with statins despite manifest hyperlipidemia. Hypertension was found in over 80% of patients. There was no significant correlation between body mass index (BMI) and maximum AAA transverse diameter. The maximum AAA diameter had no influence on the decision for a specific surgical method. Endovascular treatment resulted in shorter operating times, hospitalization, and intensive care unit (ICU) stays. Reinterventions were mainly observed after EVAR procedures. The 30-day mortality in the OAR cohort was 2%, while there was no death within 30 days after EVAR. Overall mortality was comparable in the trend analysis.

conclusionThe investigations confirmed the results of other working groups, in particular the quality assurance of the German Society for Vascular Surgery and Vascular Medicine, that the early advantages of endovascular treatment of infrarenal AAA are reflected in long-term follow-up. The decision for one particular treatment method cannot be made across the board based on the above results. It should be made individually with the patient, also based on patient-associated characteristics, and include transparency of the advantages and disadvantages of each method.