Key result
Endovascular aneurysm repair for abdominal aortic aneurysm had a similar 30-day mortality rate compared to open surgical repair (3% vs 0%; p=0.145), but a higher re-intervention rate (HR 6.4).
Why the study?
Randomized trials report lower operative mortality with EVAR versus OSR for AAA, but many cohort studies show similar mortality rates.
Does EVAR compared to open surgical repair improve 30-day mortality and secondary outcomes in patients with abdominal aortic aneurysms?
Cohort (n=162)
No
Does EVAR compared to open surgical repair improve 30-day mortality and secondary outcomes in patients with abdominal aortic aneurysms?
Absolute Event Rate: 3% vs 0%
p-value: p=0.145
In AAA repair, EVAR and OSR have similar 30-day mortality and overall survival, but EVAR offers shorter hospital stays and less blood loss at the expense of higher re-intervention rates and costs.
Hypothesis-generating for tailored AAA repair; leaves open multicenter RCTs to confirm re-intervention and cost trade-offs.
BACKGROUND: Operative mortality after endovascular aneurysm repair (EVAR) has been reported as lower than open surgical repair (OSR) for abdominal aortic aneurysm (AAA) in randomized controlled trials. However, many cohort studies have demonstrated similar mortality rates for both procedures. We compared operative mortality between EVAR and OSR, at our institution. METHODS: All AAA operations from 2012 to 2017 were reviewed, and baseline characteristics were collected. Outcomes included 30-day mortality, operative data, complications, length of hospital stay (LOS), costs, re-intervention, and survival rates were compared. A multivariable analysis with unbalanced characteristics was performed. RESULTS: We had a total of 162 patients, 100 having OSR and 62 for EVAR. The EVAR group was older, with higher ASA classification. Thirty-day mortality rate did not significantly differ (0/100 for OSR and 2/62 (3%) for EVAR; p = 0.145), while the EVAR group had less blood loss, shorter operative times, and LOS, but higher re-intervention rates (adjusted hazard ratio 6.4 (95%CI: 1.4, 26.8)). Survival rates did not significantly differ between the groups. EVAR cost approximately 1-million yen more. CONCLUSIONS: OSR had low 30-day mortality rate in selected low-risk patients whereas EVAR had less blood loss, shorter operative times, LOS and could be done in high-risk patients with low 30-day mortality but with higher re-intervention rate.
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Siribumrungwong et al. (2021) conducted a cohort in Abdominal aortic aneurysm (AAA) (n=162). Endovascular aneurysm repair (EVAR) vs. Open surgical repair (OSR) was evaluated on 30-day mortality (p=0.145). Endovascular aneurysm repair for abdominal aortic aneurysm had a similar 30-day mortality rate compared to open surgical repair (3% vs 0%; p=0.145), but a higher re-intervention rate (HR 6.4).
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