title: Comparison of outcomes after endovascular and open repair of abdominal aortic aneurysms in low-risk patients.
abstract: BACKGROUND
  In randomized trials endovascular aortic aneurysm repair (EVAR) has been shown to have superior perioperative outcomes compared with open aneurysm repair (OAR). However, outcomes in patients at low risk of complications are unclear and many surgeons still prefer OAR in this cohort. The objective was to analyse perioperative and longer-term outcomes of OAR and EVAR in this low-risk group of patients.
  
  
  METHODS
  All elective infrarenal EVARs and OARs in the Vascular Study Group of New England database were reviewed from 2003 to 2014. The Medicare scoring system was used to identity patients at low risk of perioperative complications and death. Perioperative and longer-term outcomes were analysed in this cohort. A Kaplan-Meier plot was constructed for evaluation of longer-term survival. Further propensity matching and multivariable analysis were performed to analyse additional differences between the two groups.
  
  
  RESULTS
  Some 1070 patients who underwent EVAR and 476 who had OAR were identified. Mean(s.d.) age was 67·3(5·7) and 65·1(6·3) years respectively (P < 0·001). EVAR was associated with a lower overall perioperative complication rate (4·2 versus 26·5 per cent; P < 0·001). There was no difference in 30-day mortality (0·4 versus 0·6 per cent; P = 0·446). Overall survival at 3 years was similar after EVAR and OAR (92·5 versus 92·1 per cent respectively; P = 0·592). In multivariable analyses there was no difference in freedom from reintervention (odds ratio 1·69, 95 per cent c.i. 0·73 to 3·90; P = 0·220) or survival (hazard ratio 0·85, 0·61 to 1·20; P = 0·353).
  
  
  CONCLUSIONS
  In patients predicted to be at low risk of perioperative death following aneurysm repair, EVAR resulted in fewer perioperative complications than OAR. However, perioperative mortality, reinterventions and survival rates in the longer term appeared similar between endovascular and open repair.
authors.affiliation: Division of Vascular and Endovascular Surgery, Boston Medical Center, Massachusetts, USA.
authors.forename: J J
authors.initials: JJ
authors.lastname: Siracuse
authors.affiliation: Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: M L
authors.initials: ML
authors.lastname: Schermerhorn
authors.affiliation: Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: Meltzer
authors.affiliation: Division of Vascular and Endovascular Surgery, Boston Medical Center, Massachusetts, USA.
authors.forename: M H
authors.initials: MH
authors.lastname: Eslami
authors.affiliation: Division of Vascular and Endovascular Surgery, Boston Medical Center, Massachusetts, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Kalish
authors.affiliation: Department of Biostatistics, Boston University, School of Medicine, Massachusetts, USA.
authors.forename: D
authors.initials: D
authors.lastname: Rybin
authors.affiliation: Department of Biostatistics, Boston University, School of Medicine, Massachusetts, USA.
authors.forename: G
authors.initials: G
authors.lastname: Doros
authors.affiliation: Division of Vascular and Endovascular Surgery, Boston Medical Center, Massachusetts, USA.
authors.forename: A
authors.initials: A
authors.lastname: Farber
mesh_terms: D000328:Adult; D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D057510:Endovascular Procedures; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D009511:New England / Q000453:epidemiology; D011183:Postoperative Complications; D019233:Retreatment / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment