Perioperative complications and early outcome after endovascular and open surgical repair of abdominal aortic aneurysms.
BACKGROUND
Open repair (OR) of abdominal aortic aneurysms (AAAs) is a major surgical procedure with elevated morbidity and a low but definite mortality. Advocates of endovascular repair (EVAR) claim decreased complication rates and outcome equal to OR.


METHODS
Data of all patients with infrarenal AAA that was treated electively, both with OR and EVAR, at Mayo Clinic Rochester between December 1, 1999 and December 1, 2001 were retrospectively reviewed. Thirty-day morbidity and mortality and early clinical outcomes were assessed and compared.


RESULTS
Three hundred fifty-five patients underwent treatment: 261 patients, including 229 males and 32 females (mean age: 73 years; range: 52 to 90 years) underwent OR, and 94 patients including 85 males and 9 females (mean age: 77 years; range: 61 to 98 years) underwent EVAR (AneuRx: 53, Ancure: 38, Endologix: 3). Median AAA size was 57 mm in both groups. There were more high-risk patients in the EVAR group (27% vs 14%, P =.007). Thirty-day mortality rates were 1.1 % (3/261) for OR and 0 for EVAR (P = NS). Cardiac and pulmonary complications were less frequent after EVAR (11% vs 22%, P =.02, and 3% vs 16%, P =.001, respectively), but graft-related complications were more frequent (13% vs 4%, P =.002). The association between type of repair and cardiac, pulmonary, and graft complications remained statistically significant after adjusting for age, gender, and high-risk status. The multivariate odds ratios (EVAR vs OR) for cardiac, pulmonary, and graft complications were 0.35 (95% confidence interval [CI]: 0.17 to 0.74), 0.14 (95% CI: 0.04 to 0.47), and 3.81 (95% CI: 1.51 to 9.58), respectively. Primary and secondary patency and freedom-from-reintervention rates at 1 year were lower after EVAR (83% vs 98%, P <.001; 96% vs 99%, P =.02; 65% vs 93%, P <.001, respectively).


CONCLUSIONS
Both elective OR and EVAR can be performed with low mortality, but cardiac and pulmonary complications are less frequent and less severe after EVAR. The tradeoff of EVAR is a higher rate of graft-related complications, with more reinterventions and a lower graft patency rate at 1 year. These results should be considered before EVAR is offered to patients with AAA.
Elkouri
Stephane
S
Division of Vascular Surgery, Mayo Clinic, Rochester, MN 55905, USA.
Gloviczki
Peter
P
McKusick
Michael A
MA
Panneton
Jean M
JM
Andrews
James
J
Bower
Thomas C
TC
Noel
Audra A
AA
Harmsen
William S
WS
Hoskin
Tanya L
TL
Cherry
Kenneth
K
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods* / Q000401:mortality; D005260:Female; D006331:Heart Diseases / Q000209:etiology; D006801:Humans; D008171:Lung Diseases / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D016019:Survival Analysis; D016896:Treatment Outcome