Open surgery or endovascular treatment of the abdominal aortic aneurysm--quality assurance is urgently needed.
OBJECTIVE
The endovascular treatment of the abdominal aortic aneurysm (AAA) seemed to promise great advantages over the open surgery. The current results do not show an improvement compared to the conventional therapy. New kinds of complications have appeared. Their significance especially in the longterm course cannot be assessed today because sufficient clinical data are missing.


METHODS
Between 1991 and 1997, 784 patients were electively operated on for infrarenal AAA. The clinical data of these patients were analysed retrospectively and compared to the current results of endovascular surgery in the literature.


RESULTS
In the 784 patients treated by conventional surgery the mortality was 2.4%, the morbidity was 20.3%. The mortality of endovascular treatment ranged between 0 and 8.9%, the morbidity was 20 to 74%. Endoleaks existed in up to 32% of patients, and up to 21% of interventions were initially not successful. The mortality of conversion to open surgery was reportedly amounting 43%.


CONCLUSIONS
To confirm new standards in the therapy of AAA an overall quality assurance of endovascular and open surgery is necessary. Additionally randomised studies have to be demanded. Only that way the indications of both methods can be based upon scientific facts.
Pfeiffer
T
T
Heinrich-Heine-University, Department of Vascular Surgery, Düsseldorf, Germany.
Reiher
L
L
Grabitz
K
K
Sandmann
W
W
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000401:mortality; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D014656:Vascular Surgical Procedures / Q000401:mortality