Key result
Endovascular aneurysm repair was associated with lower in-hospital mortality (p=0.03) but higher average costs (€13,734 vs €5,989; p<0.001) compared to open surgical reconstruction.
Why the study?
Abdominal aortic aneurysm-associated mortality has remained high in Romania, prompting evaluation of whether introducing EVAR decreased mortality and identification of cost determinants.
Does endovascular aneurysm repair improve mortality and alter costs compared to open surgical reconstruction in patients with abdominal aortic aneurysm?
Observational (n=117)
Yes
Does endovascular aneurysm repair improve mortality and alter costs compared to open surgical reconstruction in patients with abdominal aortic aneurysm?
p-value: p=0.03
The selective introduction of EVAR for elective AAA cases in Romania reduced in-hospital mortality and morbidity compared to open surgery but was significantly more expensive and did not decrease overall AAA-related mortality.
Introduction Abdominal aortic aneurysm (AAA)-associated mortality has remained high in Romania over the past decade. The aim of this study was to evaluate whether the recent introduction of endovascular aneurysm repair (EVAR) has contributed to a decrease in AAA-related mortality in northwestern and central Romania and to identify the main determinants of procedure-related costs. Methods We conducted a double-center observational study comparing outcomes and costs in a prospective EVAR arm and a retrospective open surgical reconstruction (OSR) arm. Results A total of 117 patients were included (48.7% treated with EVAR; 39.3% presented with ruptured AAAs). OSR was associated with significantly higher post-intervention morbidity (greater number of complications, p < 0.01; longer intensive care unit stay, p < 0.001) and higher in-hospital mortality (p = 0.03). Overall mortality was similar to that reported in Romania before the widespread adoption of EVAR (25.6% vs. 20.3%, p = 0.36). EVAR-related average costs were significantly higher than those associated with OSR, at €13,734 (range: €10,016–€40,363) vs. €5,989 (range: €690–€68,205) (p < 0.001). Conclusions The selective introduction of EVAR for elective cases was not associated with a decrease in AAA-related mortality. EVAR remains more expensive than OSR in Romania. These findings suggest that reorganizing AAA management, particularly in emergency settings, might be an important objective in the northwestern and central regions of Romania.
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Hadadi et al. (2025) conducted an observational in Abdominal aortic aneurysm (n=117). Endovascular aneurysm repair (EVAR) vs. Open surgical reconstruction (OSR) was evaluated on in-hospital mortality (p=0.03). Endovascular aneurysm repair was associated with lower in-hospital mortality (p=0.03) but higher average costs (€13,734 vs €5,989; p<0.001) compared to open surgical reconstruction.
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