Comparison of Early-Late Results and Cost Effectivity of Open Surgical Treatment and Endovascular Interventions in Abdominal Aortic Aneurysms

Objective: In this study, we aimed to compare early and late outcomes of patients with abdominal aortic aneurysm (AAA) treated using an endovascular approach and open aneurysm repair technique. Method: A total of 171 patients who were undergoing EVAR and open surgical therapy were retrospectively analyzed under elective conditions due to abdominal aortic aneurysm via Hospital Info Management System and archive files within May 2006 and June 2014, in the Ankara University Cardiovascular Department. 126 of the patients (73,7%) were treated by endovascular (group 1) and 45 of them (26,3%) were treated with open surgery (group 2) technique. Patients with 5,5 cm or large asymptomatic aneurysms and symptomatic patients with diameter smaller than 5,5 cm are classified by aneurysm morphology evaluating preoperative CT angiography images and risk scores were made and considering the other comorbidities early and late morbidity mortality, reintervention rates, transfusion needs, hospital stay and cost effectiveness of EVAR were compared. Results: The mortality rate for patients undergoing EVAR was 2,4%, while in patients undergoing open surgical repair was found 8,9% (p <0.05). The mean length of ICU, and hospital stay were significantly lower in the patients undergoing EVAR, in comparison with open surgery. The amount of blood transfusion in patients undergoing EVAR was significantly lower than in patients treated with open surgery. It can be observed an increase in early endoleak (leakage) rates constituting 9,5% in EVAR patients, which was dropped to 3,2% in sixthmonth control. According to the consequences of cost effectiveness, it was obtained that endovascular group is considerably expensive treatment than open surgery. It should be pointed out that the post implantation syndrome rates were 14,2% and there was not noted any change on mortality outcomes. Conclusions: EVAR is a safe in early and long term follow-up that reduces mortality range in all age groups, especially over 70 years old, and in patients with comobrid factors. Therefore, EVAR treatment should be considered as a priority in anatomically suitable patients despite its high cost effectiveness.