title: Endovascular repair of abdominal aortic aneurysm does not improve early survival versus open repair in patients younger than 60 years.
abstract: OBJECTIVE
  Multiple randomised trials have demonstrated lower perioperative mortality after endovascular aneurysm repair (EVAR) compared to open surgical repair for infrarenal abdominal aortic aneurysms (AAAs). However, in these trials the mortality advantage for EVAR is being lost within 2 years of repair and the patients evaluated are relatively older with no study specifically comparing EVAR and open repair for patients younger than 60 years of age.
  
  
  METHODS
  A retrospective analysis of prospectively collected data.
  
  
  METHODS
  Patients younger than 60 years of age who underwent EVAR and open surgical repair for elective infrarenal AAA were identified from the 2007-09 National Surgical Quality Improvement Program (NSQIP) - a prospective database maintained at 237 centres across the United States. Univariate and multivariate analyses were performed.
  
  
  RESULTS
  Of the 651 patients, 369 (56.7%) underwent EVAR and 282 (43.3%) underwent open repair. Thirty-day mortality for EVAR and open repair were 1.1% and 0.4%, respectively. This was not significantly different on univariate (P = 0.22) as well as multivariate (P = 0.69) analysis after controlling for other co-morbidities. On multivariate analysis, body mass index, history of stroke and bleeding disorder prior to surgery were associated with a higher 30-day mortality after AAA repair (combined open and EVAR).
  
  
  CONCLUSIONS
  These contemporary results demonstrate that the 30-day mortality rate after open repair is similar to that after EVAR in patients younger than 60 years with infrarenal AAA.
authors.affiliation: Department of Surgery, Creighton University, Omaha, NE 68131, USA.
authors.forename: P K
authors.initials: PK
authors.lastname: Gupta
authors.forename: B
authors.initials: B
authors.lastname: Ramanan
authors.forename: T G
authors.initials: TG
authors.lastname: Lynch
authors.forename: H
authors.initials: H
authors.lastname: Gupta
authors.forename: X
authors.initials: X
authors.lastname: Fang
authors.forename: M
authors.initials: M
authors.lastname: Balters
authors.forename: J M
authors.initials: JM
authors.lastname: Johanning
authors.forename: G M
authors.initials: GM
authors.lastname: Longo
authors.forename: J N
authors.initials: JN
authors.lastname: MacTaggart
authors.forename: I I
authors.initials: II
authors.lastname: Pipinos
mesh_terms: D000367:Age Factors; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000401:mortality*; D016208:Databases, Factual; D057510:Endovascular Procedures / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis