title: Open versus endovascular AAA repair in patients who are morphological candidates for endovascular treatment.
abstract: OBJECTIVE
  To compare the outcomes of open versus endovascular repair of abdominal aortic aneurysm (AAA) in a cohort of patients who fulfill morphological criteria for endovascular repair.
  
  
  METHODS
  A retrospective review of 229 consecutive AAA patients treated over a 3-year period identified 149 patients who were candidates for endovascular repair based on preoperative computed tomography and angiography. Of the 149 patients, 79 (68 men; mean age 74 +/- 8 years) underwent endovascular repair with the AneuRx stent-graft; the remaining 70 (56 men; mean age 72 +/- 8 years) had open repair. Short-term outcome measures were 30-day mortality and procedure-related morbidity, length of stay in the intensive care unit and hospital, intraoperative blood loss, interval to oral diet, and time to ambulation. Long-term outcome measures included death and secondary procedures.
  
  
  RESULTS
  There was no difference in the 30-day mortality between endovascular repair (2, 2.5%) and open repair (2, 2.9%), even though endovascular patients had more comorbidities (p<0.05). Overall length of stay was reduced for endovascular patients (3.9 +/- 2.4 days versus 7.7 +/- 3.1 days for surgical patients, p<0.0001). Fewer endograft patients had complications (24% versus 40% for open repair, p<0.05), and the severity of these complications was less, as evidenced by the shorter hospital stays for endovascular patients with complications compared to conventionally treated patients with complications (6.7 +/- 2.4 days versus 22.5 +/- 35.2 days, p<0.05). There were no aneurysm ruptures or late surgical conversions in either group.
  
  
  CONCLUSIONS
  Patients with AAA who were endograft candidates but who were treated with open repair experienced more morbidity and had more complications than patients treated with stent-grafts. Despite increased comorbidities in the endograft patients, there was no increase in mortality compared to open repair. Both treatments required secondary procedures and appeared to be equally effective in preventing aneurysm rupture up to 3 years.
authors.affiliation: Division of Vascular Surgery, Stanford University Medical Center, 300 Pasteur Drive H-3638, Stanford, CA 94305-5642, USA. bhill@stanford.edu
authors.forename: Bradley B
authors.initials: BB
authors.lastname: Hill
authors.forename: Yehuda G
authors.initials: YG
authors.lastname: Wolf
authors.forename: W Anthony
authors.initials: WA
authors.lastname: Lee
authors.forename: Frank R
authors.initials: FR
authors.lastname: Arko
authors.forename: Cornelius
authors.initials: C
authors.lastname: Olcott
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Schubart
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Dalman
authors.forename: E John
authors.initials: EJ
authors.lastname: Harris
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Fogarty
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Zarins
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D013504:Cardiovascular Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D015607:Stents; D016019:Survival Analysis; D016896:Treatment Outcome