Mid-term results of endovascular versus open repair for abdominal aortic aneurysm in patients anatomically suitable for endovascular repair

Abstract

Objectives: To prospectively evaluate the mid-term results of endovascular and open repair in patients with abdominal aortic aneurysm (AAA) anatomically suitable for endovascular repair. Material and methods: Between January 1995 and March 1999, among 438 patients treated for AAA, 180 (41%) were suitable for endovascular repair as assessed by computed tomography (CT) scan and angiogram. Seventy-three were treated by various commercially available endovascular grafts (EV) and 107 by open repair (OR). Postoperatively, patients were followed every 6 months with clinical examination, duplex scan and in the EV group, CT scans. Patients' demographic data, intra- and postoperative events were recorded prospectively in a computerised database and compared for each group. Results: Median age, sex ratio, preoperative risk factors and aneurysm diameters were not statistically different between the two groups. Respectively in the EV and OR, the average duration of operation was 149 ± 73 mn, and 133 ± 44 mn (NS), blood loss 96 ml ± 28 and 985 ml ± 113 (p<0.01), duration of hospitalisation 7 days ± 2 and 13 days ± 7 (p<0.01). The one-month mortality was 2.7% (n=2) for EV and 2.8% (n=3) for OR. The rate of cardiac and pulmonary complications was significantly higher in the OR group (6.9% versus 19.6%, p = 0.017). At a mean follow-up of 1 year, the cumulative survival rate was 82.2% ± 7.5 for EV and 96% ± 2.12 for OR (log-rank test p = 0.043). No patients died of rupture, but three patients had to be converted to open surgery. Twenty-two percent (n=16) patients in the EV and 7.5% (n=8) in the OR were submitted to a subsequent minor or major reintervention (p = 0.007). At 1 year, the cumulative rates free of any reintervention were respectively 78.8% ± 6.7% and 92.9% ± 2.7% (p = 0.001). In the EV there were 17 early endoleaks (23.3%). At the end of patient's follow-up seven endoleaks (9.6%) persisted. The primary success rate defined by the absence of endoleak and the absence of reintervention was 54 (74%) with EV and 101 (94%) with OR (p = 0.001). Conclusion: EV is a promising technique. However, with current devices and indications the immediate benefits, mainly less blood loss, fewer cardiac and pulmonary complications, and shorter hospitalisation time, are outweighed by a higher rate of reinterventions to treat endoleak, or to maintain patency of the graft.