title: Reintervention after EVAR and open surgical repair of AAA: a 15-year experience.
abstract: OBJECTIVE
  This study examined the frequency and reason for reinterventions and their impact on survival in contemporaneously treated cohorts of EVAR and open surgical repair (OSR) patients.
  
  
  BACKGROUND
  EVAR has largely replaced OSR for anatomically appropriate AAA because of improved short-term outcomes. However, EVAR is associated with a notable reintervention rate.
  
  
  METHODS
  Data for patients undergoing elective AAA repair between 1996 and 2011 were collected and analyzed to assess time from initial procedure to reintervention and rate of reintervention. Patient demographics, comorbidities, number and type of reinterventions, graft type, and timing of reintervention were analyzed.
  
  
  RESULTS
  A total of 1144 patients underwent AAA repair; 558 had EVAR and 586 had OSR. In 76 EVAR patients, 123 reinterventions were performed; 46 reinterventions were performed in 30 OSR patients (P < 0.0001). Endoleak was responsible for 66% of EVAR reinterventions; colonic ischemia, bleeding, and incisional hernias caused 30%, 22%, and 22% of OSR reinterventions, respectively. Time to first reintervention was shorter in OSR patients (P < 0.001) and was related to AAA size (P < 0.001). Early reintervention at the index procedure in OSR patients had a 23% mortality rate. If reinterventions were not required, survival curves were similar. Current endografts require fewer reinterventions than earlier generation endografts.
  
  
  CONCLUSIONS
  Reintervention was more common with EVAR and occurred later. Early reintervention after OSR is associated with significant mortality. If early reintervention in OSR patients can be avoided, there is no early survival advantage to EVAR. Current endografts require fewer reinterventions than earlier devices.
authors.affiliation: From the Jobst Vascular Institute, ProMedica Toledo Hospital, Toledo, OH.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Al-Jubouri
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Comerota
authors.forename: Subhash
authors.initials: S
authors.lastname: Thakur
authors.forename: Faisal
authors.initials: F
authors.lastname: Aziz
authors.forename: Steven
authors.initials: S
authors.lastname: Wanjiku
authors.forename: David
authors.initials: D
authors.lastname: Paolini
authors.forename: John P
authors.initials: JP
authors.lastname: Pigott
authors.forename: Fedor
authors.initials: F
authors.lastname: Lurie
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D017558:Elective Surgical Procedures / Q000379:methods* / Q000401:mortality; D057510:Endovascular Procedures / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000601:surgery; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome