title: Durability and survival are similar after elective endovascular and open repair of abdominal aortic aneurysms in younger patients.
abstract: OBJECTIVE
  The role of endovascular repair (EVAR) of aortic aneurysms in young patients is controversial. The purpose of this study was to determine the long-term outcomes and reintervention rates in patients 60 years of age or younger who underwent elective open or endovascular repair of an abdominal aortic aneurysm.
  
  
  METHODS
  Retrospective review of a prospectively collected vascular surgery database at a university-affiliated medical center was performed to identify all patients who underwent elective repair of an abdominal aortic aneurysm between 2000 and 2013 and were 60 years of age or younger at the time of the repair. Preoperative anatomic measurements were performed and compared with instructions for use (IFU) criteria for the endografts.
  
  
  RESULTS
  The study cohort comprised 169 patients 60 years of age or younger (mean age, 56.7 ± 2.8 years) who underwent elective repair (119 open repair, 50 EVAR). Patients treated with open repair and EVAR had similar comorbidities, except that EVAR patients were more likely to have hypertension (P = .03) and poor left ventricular function (P = .04). The open repair group had significantly larger suprarenal (P = .004) and infrarenal (P = .005) neck angles, shorter neck lengths (P < .001), and larger maximum aneurysm diameter (P = .02) compared with the EVAR group. Only five patients (13%) in the EVAR group did not meet all IFU criteria. The overall in-hospital mortality rate was 1.8% (0% EVAR, 2.5% open repair; P = .56). Overall mean life expectancy was 11.5 years (9.8 years EVAR, 11.9 years open repair; P = .09). The 1-year (98% EVAR, 96% open repair), 5-year (86% EVAR, 88% open repair), and 10-year (54% EVAR, 75% open repair) survival did not differ between EVAR and open repair (P = .16). Long-term survival (78% EVAR, 85% open repair; P = .09) and reintervention rates (12% EVAR, 16% open repair; P = .80) did not differ. No late aneurysm rupture or aneurysm-related deaths were observed. The most common causes of long-term mortality were malignant disease and cardiovascular events. Reinterventions in the open repair group were exclusively laparotomy related (incisional hernia repairs), whereas all reinterventions in the EVAR group were aortic related, including one conversion to open repair.
  
  
  CONCLUSIONS
  After elective aneurysm repair, younger patients have a moderate life expectancy related to malignant disease and cardiovascular health. EVAR offers durability and long-term survival similar to those with open repair in these younger patients as long as aneurysm anatomy and IFU are adhered to.
authors.affiliation: Division of Vascular Surgery, London Health Sciences Centre and The University of Western Ontario, London, Ontario, Canada.
authors.forename: Kevin
authors.initials: K
authors.lastname: Lee
authors.affiliation: Division of Vascular Surgery, London Health Sciences Centre and The University of Western Ontario, London, Ontario, Canada.
authors.forename: Elaine
authors.initials: E
authors.lastname: Tang
authors.affiliation: Division of Vascular Surgery, London Health Sciences Centre and The University of Western Ontario, London, Ontario, Canada.
authors.forename: Luc
authors.initials: L
authors.lastname: Dubois
authors.affiliation: Division of Vascular Surgery, London Health Sciences Centre and The University of Western Ontario, London, Ontario, Canada.
authors.forename: Adam H
authors.initials: AH
authors.lastname: Power
authors.affiliation: Division of Vascular Surgery, London Health Sciences Centre and The University of Western Ontario, London, Ontario, Canada.
authors.forename: Guy
authors.initials: G
authors.lastname: DeRose
authors.affiliation: Division of Vascular Surgery, London Health Sciences Centre and The University of Western Ontario, London, Ontario, Canada. Electronic address: thomas.forbes@uhn.ca.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Forbes
mesh_terms: D000046:Academic Medical Centers; D000367:Age Factors; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D002423:Cause of Death; D015897:Comorbidity; D017558:Elective Surgical Procedures; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D009864:Ontario; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D011474:Prosthesis Design; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome