Endovascular aortic repair reduced in-hospital mortality to 0.93% compared to 3.48% with open surgical repair in patients with intact abdominal aortic aneurysms.
Observational (n=1,237)
No
Does endovascular aortic repair (EVAR) reduce in-hospital mortality compared to open surgical repair (OSR) in patients with intact abdominal aortic aneurysms?
EVAR is associated with lower in-hospital mortality but worse long-term survival compared to open surgical repair for intact abdominal aortic aneurysms.
Effect estimate: OR 0.16 (95% CI 0.06–0.43)
Absolute Event Rate: 0.93% vs 3.48%
p-value: p=<0.001
Background: Endovascular aortic repair (EVAR) has become the standard approach for intact abdominal aortic aneurysm (iAAA) repair in recent decades. This retrospective single-centre study analyzed real-world treatment trends, early outcomes, and risk factors for in-hospital mortality following EVAR and open surgical repair (OSR) in patients treated for iAAA from 2005 to 2022. Methods: In-hospital mortality was the primary outcome. Univariate and multivariable logistic regression analyses were performed. Logistic and logarithmic regression models were established to assess temporal changes. Results: In total, 1237 patients (90% male, mean age 72 years) were included, comprising 863 EVAR and 374 OSR procedures. In-hospital mortality was lower after EVAR than OSR (0.93% vs. 3.48%; p = 0.001). After risk adjustment, higher age (adjusted odds ratio OR 2.39, 95% confidence interval CI 1.26–4.78; p = 0.007) and chronic obstructive pulmonary disease (OR 4.43, 95% CI 1.82–10.8; p = 0.001) were associated with higher in-hospital mortality. Conversely, EVAR (vs. OSR; OR 0.16, 95% CI 0.06–0.43; p < 0.001) was associated with a lower hospital mortality risk. Throughout the study, in-hospital mortality rates for EVAR and OSR remained stable. With a median follow-up of 21 months, OSR-treated patients presented prolonged survival during follow-up (p = 0.021). Conclusions: EVAR represents a reliable alternative for elderly patients with multiple comorbidities considered unfit for OSR. Although EVAR was associated with lower in-hospital mortality, survival was lower during the 5-year follow-up compared to OSR.
Carrillo et al. (2026) conducted an observational in Patients with intact (non-ruptured) abdominal aortic aneurysms undergoing repair (including juxtarenal and infrarenal aneurysms) (n=1,237). Endovascular aortic repair (EVAR) vs. Open surgical repair (OSR) was evaluated on In-hospital mortality (death during hospitalization after index procedure) (OR 0.16, 95% CI 0.06–0.43, p=<0.001). Endovascular aortic repair reduced in-hospital mortality to 0.93% compared to 3.48% with open surgical repair in patients with intact abdominal aortic aneurysms.