title: Early and long-term outcomes after open or endovascular repair for abdominal aortic aneurysms in high-risk patients.
abstract: OBJECTIVE
  The aim of our study was to evaluate the earlier and long term survival as well the postoperative complications in high-risk patients who received endovascular aortic repair (EVAR) as first choice, or open repair when anatomical requirements for EVAR were not met.
  
  
  METHODS
  Between January 2005 and January 2010, 593 patients underwent procedures for elective abdominal aortic aneurysm (AAA) repair; 172 of these were considered at high risk according to the American Society of Anesthesiology (ASA) score (ASA III and IV): 150 high-risk patients were males (mean age 72.7, range 53-93 years) and 22 females (mean age 72.9 years, range 60-90 years). The median AAA diameter was 64 (53-75) mm in the open repair group and 62 (55-70) mm in the EVAR group. 121 patients underwent open repair and 51 EVAR, respectively.
  
  
  RESULTS
  The 30-day mortality rate was 0% in the EVAR group and 2.4% (3/121) in the open repair group (P=0.26). Long-term results showed: no EVAR-related mortality, no late conversion to open repair in the EVAR group was required during follow-up. No aneurysmal expansion was observed. In the open repair group, no graft-related events were observed during follow-up. The mean follow-up for survival analysis was 1542 days. Overall 5-year survival was 71.7% (SE=4.2%). Survival during follow-up was 92.2%, 86.1%, 76.2%, 65.9% and 61.8% at 12, 24,36,48,60 months respectively in EVAR Group. Open Group present long term survival of 95%, 88.9%, 83.9%, 79.7%, 76% at 12, 24, 36, 48, 60 months respectively.
  
  
  CONCLUSIONS
  Our results in open repair surgery show a perioperative low mortality rate with high survival rate in long term. This result could be successfully achieved even in high-risk patients unsuitable for EVAR.
authors.affiliation: Vascular and Endovascular Surgery Unit University Hospital IRCCS San Martino‑IST University of Genoa, Genoa, Italy - spinella.giovannisg@gmail.com.
authors.forename: B
authors.initials: B
authors.lastname: Pane
authors.forename: G
authors.initials: G
authors.lastname: Spinella
authors.forename: A
authors.initials: A
authors.lastname: Signori
authors.forename: D
authors.initials: D
authors.lastname: Musio
authors.forename: M G
authors.initials: MG
authors.lastname: Perfumo
authors.forename: G
authors.initials: G
authors.lastname: Lucertini
authors.forename: N
authors.initials: N
authors.lastname: Rousas
authors.forename: D
authors.initials: D
authors.lastname: Palombo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018579:Patient Selection; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome