Abstract
We conducted a retrospective study to compare treatment outcome and procedure-related reintervention rates of endovascular aneurysm repair (EVAR) with those of open repair. Clinical and radiological data of patients treated at the Rijnstate Hospital (Arnhem, The Netherlands) for nonsymptomatic aortic abdominal aneurysm during October 1998-January 2004 were reviewed and analyzed for demographic data, aneurysm specifics, comorbid condition status, and perioperative outcome. There were 99 patients treated with EVAR and 116 patients treated with open repair. Significant differences in age were seen between treatment groups, patients under the age of 80 being more likely to have open repair (p < 0.004). The EVAR group consisted of significantly fewer women (p < 0.029). Of seven comorbid conditions, four reached significant differences between treatment groups; patients with ischemic heart disease (p < 0.044), heart failure (p < 0.006), renal failure (p < 0.033), or peripheral arterial disease (p < 0.006) were more likely to have EVAR. Comparison of aneurysm anatomy showed no difference in size between EVAR (mean 57.7 mm, 95% CI 55.9-59.5 mm) and open repair (mean 60.1 mm, 95% CI 57.9-62.3 mm). Significant differences were seen in aneurysm neck length and diameter. Operative outcome showed differences in length of hospital stay (median, EVAR 7 vs. open repair 11 days), 30-day mortality (p < 0.048), postoperative hematoma (p < 0.001), and postoperative pulmonary infections (p < 0.001), all in favor of EVAR. Follow-up of the EVAR group showed a decrease (mean 10 mm, 95% CI 7-14 mm) of aneurysm diameter in 15% of cases during follow-up (mean 18 months, range 1-66). Despite higher age and more comorbidity of patients undergoing EVAR, 30-day mortality, postoperative pulmonary infection rate, and length of hospital stay were lower than for those undergoing open repair. Both EVAR and open repair can be performed on a subset of patients with low mortality, complication, and reintervention rates.
Similar content being viewed by others
References
Ruiz C, Zhang HP. A novel method for treatment of abdominal aortic aneurysms using percutaneous implantation of a newly designed endovascular device. Circulation 1995;91:2470-2477
Petrasek PF, White GH, May J. Novel aortic reconstruction strategies: endovascular aneurysm repair. Curr. Intervent. Cardiol. Rep. 1999;1:205-214
Ailawadi G, Eliason J. Current concepts in the pathogenesis of abdominal aortic aneurysm. J. Vasc. Surg. 2003;38:584-588
Lederle F, Johnson G, Wilson S, et al. Rupture rate of large abdominal aortic aneurysms in patients refusing or unfit for elective repair. J.A.M.A. 2002;287:2968-2972
United Kingdom Small Aneurysm Trial Participants. Long-term outcomes of immediate repair compared with surveillance of small abdominal aortic aneurysms. N. Engl. J. Med. 2002;346:1445-1452.
Parodi JC, Palmaz JC. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann. Vasc. Surg. 1991;5:491-499
Elkouri S, Gloviczki P, McKusick MA, et al. Perioperative complications and early outcome after endovascular and open surgical repair of abdominal aortic aneurysms. J. Vasc. Surg. 2004;39:497-505
Lee WA, Carter JW, Upchurch G, et al. Perioperative outcomes after open and endovascular repair of intact abdominal aortic aneurysms in the United States during 2001. J. Vasc. Surg. 2004;39:491-496
Wolf YG, Arko FR, Hill BB, et al. Gender differences in endovascular abdominal aortic aneurysm repair with the AneuRx stent graft. J. Vasc. Surg. 2002;35:882-886
Katz DJ, Stanley JC, Zelenock GB, et al. Gender differences in abdominal aortic aneurysm prevalence, treatment, and outcome. J. Vasc. Surg. 1997;25:561-568
Becquemin J, Kelley L, Zubilewicz T, et al. Outcomes of secondary interventions after abdominal aortic aneurysm endovascular repair. J. Vasc. Surg. 2004;39:298-305
May J, White G, Waugh R, et al. Adverse events after endoluminal repair of abdominal aortic aneurysms: a comparison during two successive periods of time. J. Vasc. Surg. 1999;29:32-37
Arko F, Filis K, Hill BB, et al. Morphologic changes and outcome following endovascular abdominal aortic aneurysm repair as a function of aneurysm size. Arch. Surg. 2003;138:651-656
Zarins CK, Bloch DA, Crabtree T, et al. Aneurysm enlargement following endovascular aneurysm repair: AneuRx clinical trial. J. Vasc. Surg. 2004;39:109-117
Terramani T, Chaikof EL, Rayan SS, et al. Secondary conversion due to failed endovascular abdominal aortic aneurysm repair. J. Vasc. Surg. 2003;38:473-478
Steinmetz E, Rubin B, Sanchez LA, et al. Type II endoleak after endovascular abdominal aortic aneurysm repair: a conservative approach with selective intervention is safe and cost-effective. J. Vasc. Surg. 2004;39:306-313
Peppelenbosch N, Buth J, Harris PL, et al. Diameter of abdominal aortic aneurysm and outcome of endovascular aneurysm repair: does size matter? A report from Eurostar. J. Vasc. Surg. 2004;39:288-297
Ouriel K, Clair DG, Greenberg RK, et al. Endovascular repair of abdominal aortic aneurysms: device-specific outcome. 2003;37:991-998
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Aarts, F., van Sterkenburg, S. & Blankensteijn, J. Endovascular Aneurysm Repair versus Open Aneurysm Repair: Comparison of Treatment Outcome and Procedure-Related Reintervention Rate. Ann Vasc Surg 19, 699–704 (2005). https://doi.org/10.1007/s10016-005-6861-1
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10016-005-6861-1