Comparable perioperative mortality outcomes in younger patients undergoing elective open and endovascular abdominal aortic aneurysm repair

Abstract

In this study of younger patients undergoing repair of infrarenal AAA, 30-day morbidity and mortality for both open surgery and EVAR are low, and the absolute mortality difference is small. The prior published perioperative mortality and 1-year survival benefit of EVAR over open AAA repair is not observed in younger patients. Further studies of long-term durability are needed to guide decision-making for open repair vs EVAR in this population.

Meta-analysis of long-term survival after elective endovascular or open repair of abdominal aortic aneurysm

“…Some 3061 articles were identified, of which 115 were selected and read in full. Eventually 53 studies fulfilled the inclusion criteria ( Fig . ).…”

Impact of Gradual Adoption of EVAR in Elective Repair of Abdominal Aortic Aneurysm: A Retrospective Cohort Study from 2009 to 2015

“…The less degree of complications leads to shorter median LOS after EVAR than after OSR, as confirmed by other studies, 19,20 both in older 21 and younger patients. 7 Consistent with these results, in many centers, the strategy of risk-benefit assessment has been replaced by an EVAR first approach, if the AAA is anatomically suitable. This is in accordance with the recent guidelines from the European Society for Vascular Surgery that recommend EVAR in most patients with suitable anatomy and reasonable life expectancy as the preferred treatment modality, being reasonable to suggest an OSR first strategy in younger, fit patients with a long life expectancy >10e15 years.…”

“…Accordingly, recent observational studies reported significantly lower postoperative complications among patients who underwent EVAR, namely lower rates of acute bowel ischemia, renal, and respiratory insufficiency 20 but also fewer rates of myocardial infarction and dysrhythmia. 7 OSR repair is a high-risk procedure which results in a severe surgical stress response. It is plausible that the lower rates of systemic complications after EVAR are due to a significantly higher incidence of systemic inflammatory response in patients who underwent OSR than in EVAR.…”

“…In fact, the development of surgical techniques, perioperative management, and the introduction of endovascular exclusion strategies contributed to lower the elective surgical mortality to less than 5% in most series. 5 Despite administrative data published with favorable long-term outcomes of EVAR, 6,7 meta-analysis of randomized control trials comparing both techniques 8 shows that EVAR compares favorably with OSR during the first six months, but it carried an increased risk of aneurysm-related mortality after eight years. These conflicting results underlie the need for local real-world reports with both shortand long-term outcomes after AAA repair.…”

Does the choice of intraoperative fluid modify abdominal aneurysm repair outcomes?

“…Moreover, EVAR is a less invasive procedure and could explain the lower morbidity, as compared to the more complex AAA-OR. In a recent study, Liang et al [36] compared perioperative and short-term outcomes in younger (<65 years) EVAR and AAA-OR patients, and found that the propensity-weighted procedural mortality rates of EVAR and AAA-OR are fairly comparable.…”