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 24 February 2018

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News

Endovascular vs open repair of abdominal aortic aneurysms

This week's issue of the New England Journal of Medicine compares endovascular vs open repair of abdominal aortic aneurysms.

News image

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Randomized trials have shown reductions in perioperative mortality and morbidity with endovascular repair of abdominal aortic aneurysm, as compared with open surgical repair.

Longer-term survival rates, however, were similar for the 2 procedures.

There are currently no long-term, population-based data from the comparison of these strategies.

Dr Marc Schermerhorn and colleagues studied perioperative rates of death and complications after open vs endovascular repair of abdominal aortic aneurysm.

In addition, the team evaluated long-term survival, rupture, and reinterventions after open as compared with endovascular repair of abdominal aortic aneurysm.

Laparotomy-related complications are more likely in those who underwent open repair
New England Journal of Medicine

The team assessed propensity-score-matched cohorts of Medicare beneficiaries undergoing repair during the 2001to 2004 period, with follow-up until 2005.

There were 22,830 matched patients undergoing open repair of abdominal aortic aneurysm in each cohort.

The average age of the patients was 76 years, and approximately 20% were women.

Perioperative mortality was lower after endovascular repair than after open repair, and the reduction in mortality increased with age.

The team noted that late survival was similar in the 2 cohorts, although the survival curves did not converge until after 3 years.

By 4 years, rupture was more likely in the endovascular-repair cohort than in the open-repair cohort

The team also found that reintervention related to abdominal aortic aneurysm, although most reinterventions were minor.

In contrast, by 4 years, surgery for laparotomy-related complications was more likely among patients who had undergone open repair.

Dr Schermerhorn's team concludes, "As compared with open repair, endovascular repair of abdominal aortic aneurysm is associated with lower short-term rates of death and complications."

"The survival advantage is more durable among older patients."

"Late reinterventions related to abdominal aortic aneurysm are more common after endovascular repair but are balanced by an increase in laparotomy-related reinterventions and hospitalizations after open surgery."

NEJM 2008: 358(5): 464-74
01 February 2008

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