Survival Comparison of Patients Undergoing Secondary Aortic Repair

Introduction. Infrarenal abdominal aortic aneurysm (AAA) repair warrants lifelong surveillance. Secondary aortic intervention (SAI) outcomes may be affected by the therapeutic approach. We compared short- and long-term mortality in patients who underwent SAIs after initial aortic repair, either endovascular (EVAR) or open. Methods. Patients who underwent AAA repair between 1986 and 2010 were retrospectively identified in a vascular surgery database as well as those who underwent SAIs. All-cause mortality and Kaplan-Meier survival curves were calculated. Results. We identified 149 patients who underwent either open AAA repair or EVAR followed by open or endovascular SAI. Seventy-seven patients (51.7%) underwent initial EVAR while 72 patients (48.3%) underwent open repair. Sixty (78%) initial EVAR patients underwent secondary EVAR while 17 (22%) patients had an open SAI. Initial open repair patients were evenly distributed between EVAR and open SAIs. Compared to EVAR, patients who underwent initial open repair had longer intervals between primary aortic interventions (PAIs) and SAIs. Multivariable-adjusted all-cause mortality was significantly higher for patients who underwent initial open AAA repair followed by EVAR when compared to patients who underwent endovascular PAI and SAI. Conclusion. Long-term mortality in patients with infrarenal aortic aneurysms who require SAI may be improved by an EVAR-first algorithm.