Early Outcomes of Open Abdominal Repair Versus Endovascular Repair for Abdominal Aortic Aneurysm: Report from National Hospital Organization Network Study in Japan

Abstract

Objective: Early outcomes of open abdominal repair (OS) versus endovascular repair (EVAR) forabdominal aortic aneurysm were retrospectively analyzed, after commercialized devices for EVAR had become available in Japan. Patients and Methods: A total of 781 consecutive patients (OS, n = 522; EVAR, n = 259) were treated at ten medical centers between January 2008 and September 2010. The OS group comprised patients with preoperative shock (SOS, n = 34) and without shock (NOS, n = 488). Results: Patients in the EVAR group were 3 years older than those in the NOS group. There was greater prevalence of hostile abdomen, on dialysis, chronic obstructive pulmonary disease on inhaled drug, and cerebrovascular disease in the EVAR group than in the NOS group. Surgical mortality was 16 cases (2.0% in all patients, EVAR: 0.8%, NOS: 1.4%, SOS: 21%). Hospital stay >30 days was documented in 52 (11%) with NOS, 11 (33%) with SOS, and 8 (3%) with EVAR. Thirty late deaths included 6 aneurysm related death and 14 cardiovascular causes at a mean follow up of 1.0 year. The survival rates freedom from all cause death at one year, were 95 ± 1% in NOS and 94 ± 2% in EVAR respectively. Conclusion: Though significant differences in patient characteristics among three groups were noted, early results were satisfactory.

Is Endovascular Aneurysm Repair A Relative Contraindication for Patients with Preoperative Renal Dysfunction?

“…8,9) Rates of EVAR for AAA have been increasing yearly because of the lower degree of invasiveness, with rates reaching 53% in 2011. 8,9) Rates are likely to have increased since 2011, making EVAR the main surgical method for AAA. The major differences between EVAR and OS include the risk of residual endoleak, radiation exposure, and use of contrast medium.…”

Is Conventional Open Repair for Abdominal Aortic Aneurysm Feasible in Nonagenarians?

“… 4 – 9 ) Because EVAR has several contraindications in such patients, including a short neck or a narrow access route, 10 ) whether conventional open repair should be performed remains controversial due to the increased mortality and morbidity associated with patient age. 11 , 12 ) Moreover, a small number of reports have concluded that EVAR is also suitable for nonagenarians, 4 , 5 , 8 , 9 ) although the outcomes of open repair in nonagenarians remain unclear. In the present study, the outcomes of conventional open repair for AAA were compared with those of EVAR in nonagenarian patients.…”

Late Sac Behavior after Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm

“…10,11) In brief, indications for treating infra-renal AAA in the present study were as follows: a maximum diameter greater than or equal to 5 cm or 4-5 cm with rapid enlargement of 5 mm or more over 6 months or a saccular morphology that carried a high risk of rupture. Each patient had a preoperative examination, including a multi-detector computed tomography (CT) examination according to the requirements in each participating center.…”