Has the introduction of endovascular treatment made elective repair of infrarenal abdominal aortic aneurysm safer?

Abstract

Aims: Endovascular aneurysm repair (EVAR) has become an established alternative to open repair (OR). We present 556 elective patients with infrarenal abdominal aortic aneurysm, comparing OR versus EVAR.

Methods: Prospective data collection from 1991 to 2004 was reviewed. Statistical analysis was performed using the SPSS data editor with χ2 tests and Mann–Whitney U-test (*P < 0·05).

Results: There were 556 patients with 438 OR (386 males, 52 females) with median age 71 (IQR, 66–75·5) years and 118 EVAR (109 males, 9 females) with median age 74 (IQR, 69–79)* years. For OR, there were 322 tube grafts and 116 bifurcated grafts and for EVAR 13 and 105, respectively. Total blood loss OR median 1400 (IQR 750–2450) versus 450 (IQR, 260–800)* ml. Overall mortality was 20 (4·6%) for OR and 3 (2·5%) for EVAR*. Cardiac events occurred in 15 OR and 5 EVAR*; strokes 2 OR, 0 EVAR; pneumonia 4 OR, 1 EVAR*; acute renal failure 16 OR, 2 EVAR*; 76 OR have complications, 12 EVAR*. Some 5 OR required splenectomy, 7 had ischaemic colitis and 9 had multiorgan failure; no EVAR patients had these complications. Nineteen OR patients were returned to theatre for complications compared to two in the EVAR group*. Embolectomy was required for lower limb ischaemia in 9 OR and 2 EVAR, 4 OR had femoro-popliteal/distal grafts compared to no EVAR. Two amputations were performed in OR and one in EVAR.

Conclusions: This audit shows that EVAR has lower mortality and lower complication rates compared to OR. EVAR can be achieved with good primary success, but long-term follow-up is essential to assess durability.