Long-Term Outcomes of Endovascular Repair versus Open Repair of Abdominal Aortic Aneurysm

Abstract

An alternative to open repair was initially reported by Parodi in 1991.2) A covered stent was inserted within the aneurysm by an endoluminal route via the femoral artery. About 90 per cent of AAAs can be excluded from the circulation with low risk of subsequent aneurysm rupture, thereby reducing significantly postoperative pain, critical care requirement and hospital stay. 3,4) There are numerous reports on the long-term effects of patients after EVAR, including the DREAM, EVAR1 and EVAR2 studies. [5][6][7][8] These trials showed that EVAR is more likely to be more cost-effective than open repair in terms of operative mortality with no differences in mortality or aneurysm-related mortality existing between both groups in long-term. [5][6][7][8] However, patients undergoing the EVAR procedure have a higher rate of graft-related complications and more costly reinterventions. 8,9)

Characterizing the evolution of perioperative outcomes and costs of endovascular abdominal aortic aneurysm repair

“…[1][2][3] Numerous studies have demonstrated that EVAR, in comparison to open repair of AAA, is associated with reduced perioperative mortality, morbidity, length of stay, and postoperative quality of life. [4][5][6][7][8][9] However, like all nascent technology in medicine and other fields, there is a financial burden associated with this relatively novel approach; multiple cost-effectiveness studies in a variety of settings have revealed the expense associated with EVAR. [12][13][14][15][16][17][18][19][20] High device costs, in addition to the need for postoperative surveillance, have led investigators to the conclusion that open repair may offer a more costeffective solution.…”

“…[1][2][3] Numerous studies have identified that EVAR is associated with reduced perioperative mortality, morbidity, and length of stay and higher postoperative quality of life. [4][5][6][7][8][9] This favorable perioperative risk profile, in comparison to open aneurysm repair, has resulted in swift and widespread acceptance of EVAR. 10,11 However, particularly in light of relatively high device costs for EVAR, the relative balance of the benefits and costs continues to be questioned.…”

Emergent Endovascular vs. Open Surgery Repair for Ruptured Abdominal Aortic Aneurysms: A Meta-Analysis

“…An aortic aneurysm is defined as a permanent, localized focal dilation of the aorta with an aortic diameter of 30 mm or greater is defined as an aortic aneurysm [1], [2]. Aortic aneurysms located under the diaphragm are classified as abdominal aortic aneurysms (AAA), occur more frequently than thoracic aortic aneurysms, and are responsible for approximately 15,000 deaths yearly [3], [4].…”

Early and delayed rupture after endovascular abdominal aortic aneurysm repair in a 10-year multicenter registry

“…Multiple trials have shown excellent short-term outcomes of EVAR compared with traditional open AAA repair, 2–7 but the superiority of long-term results has yet to be determined. Graft durability remains a chief concern, and lifelong radiographic surveillance has been considered mandatory to detect treatable complications such as endo-leak, device migration, and aneurysm expansion.…”