Long-term age-stratified survival following endovascular and open abdominal aortic aneurysm repair

Varkevisser, Rens R.B.; Mota, Mathijs T. Carvalho; Swerdlow, Nicholas J.; Stone, David H.; Scali, Salvatore T.; Blankensteijn, Jan D.; Verhagen, Hence J.M.; Schermerhorn, Marc L.

doi:10.1016/j.jvs.2022.03.867

Cited by 9 publications

(1 citation statement)

References 28 publications

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“…Varkevisser et al 8 compared the long-term mortality between EVAR and open abdominal aneurysm repair for patients of different ages. In their study, EVAR in patients younger than 65 was associated with higher long-term all-cause mortality compared with open repair.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcome of Intact Abdominal Aortic Aneurysm After Endovascular or Open Repair

Epple

Svidlova

Schmitz‐Rixen³

et al. 2023

Vasc Endovascular Surg

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Objective Endovascular aortic aneurysm repair (EVAR) has been established as a standard treatment option for intact abdominal aortic aneurysm (iAAA) and gained importance due to a lower perioperative mortality than open repair (OAR). However, whether this survival advantage can be maintained or if OAR is beneficial in terms of long-term complications and reinterventions remains questionable. Design In this retrospective cohort study data from patients undergoing elective EVAR or OAR for iAAAs in the years 2010-2016 was analyzed. The patients were followed through 2018. Methods In the propensity score matched cohorts the perioperative and long-term outcomes of the patients were assessed. We identified 20 683 patients undergoing elective iAAA repair (76.4% EVAR). The propensity matched cohorts included 4886 pairs of patients. Results The perioperative mortality was 1.9% for EVAR and 5.9% for OAR ( P = <.001). The perioperative mortality was mainly influenced by patients age (Odds-Ratio (OR):1.073, confidence interval (CI):1.058-1.088, P ≤ .001) and OAR (OR:3.242, CI:2.552-4.119, P ≤ .001). The early survival benefit after endovascular repair persisted for approximately 3 years (estimated survival EVAR 82.3%, OAR 80.9%, P = .021). After that time the estimated survival curves were similar. After 9 years the estimated survival was 51.2% after EVAR as compared to 52.8% after OAR ( P = .102). The operation method didn’t influence long-term survival significantly (Hazard-Ratio (HR): 1.046, CI: .975-1.122, P = .211). The vascular reintervention rate was 17.4% in the EVAR cohort and 7.1% in the OAR cohort ( P ≤ .001). Conclusion EVAR has a significantly lower perioperative mortality than OAR, a survival benefit that lasts up to 3 years after intervention. Thereafter, no significant difference in survival was observed between EVAR and OAR. The decision between EVAR or OAR may depend on patient preference, surgeons’ experience, and the institutions’ ability to handle complications.

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Section: Discussionmentioning

confidence: 99%