Key result
Endovascular aneurysm repair (EVAR) was associated with significantly worse long-term survival and higher late re-intervention rates (6 vs 0) compared to open retroperitoneal repair with ERAS.
Why the study?
Although EVAR is widely performed for infrarenal abdominal aortic aneurysms, studies show better long-term results with open repair mostly focused on midline access, leaving long-term outcomes comparing EVAR to retroperitoneal open repair with an ERAS protocol uncharacterized.
Does endovascular aneurysm repair compared to open retroperitoneal repair with ERAS protocol improve long-term survival in patients with abdominal aortic aneurysms?
Cohort (n=156)
Does endovascular aneurysm repair compared to open retroperitoneal repair with ERAS protocol improve long-term survival in patients with abdominal aortic aneurysms?
In patients with abdominal aortic aneurysms, open retroperitoneal repair with an ERAS protocol is associated with better long-term survival and fewer late re-interventions compared to EVAR, despite higher initial perioperative complications.
Hypothesis-generating for retroperitoneal open repair plus ERAS versus EVAR; prospective RCTs needed before practice change.
ObjectivesAlthough the endovascular management of infrarenal abdominal aortic aneurysms (AAAs) is widely performed, many studies have shown better long-term results with open graft repairing, mostly focusing on the classical open repair with midline access. This study aims to evaluate long-term results comparing EVAR (endovascular aneurysm repair) and surgical open repair with retroperitoneal access associated with ERAS (Enhanced Recovery After Surgery) protocol.MethodsA retrospective analysis of 156 patients treated for AAA between 2015 and 2018 was conducted. Clinical and demographic characteristics of the two groups were homogeneous except for age, which was significantly higher in patients belonging to the EVAR one, and for previous laparotomies. A total of 100 patients (58.7%) underwent open retroperitoneal repair (ORR group), and 56 (42.3%) underwent EVAR. A mean of 51 ± 28 months of follow-up was conducted. This study aims to evaluate long-term survival by comparing EVAR (endovascular aneurysm repair) and surgical open repair with retroperitoneal access associated with ERAS (Enhanced Recovery After Surgery) protocol. Secondary aims evaluate differences between the two techniques regarding late complications, need for re-interventions, and perioperative results.ResultsFreedom from all-cause mortality, calculated with Kaplan-Meier survival curves equalizing the two population with a Covariate Propensity Score, showed significant better survival rates at 1, 3, and 5 years in ORRs then in EVARs. Late complications (>30 days) and need for late re-intervention rates were greater in the EVAR group (6 late re-interventions needed vs 0 in the ORR group).Perioperative results show longer mean length of hospital stay in patients belonging to the ORR group (5 days vs 2) and significantly higher in-hospital-complication rate.ConclusionsThe long-term comparison between EVAR and open retroperitoneal repair shows significantly better late outcomes in the ORR group. The perioperative course appears significantly better in EVARs but anyway good in ORRs when a perioperative protocol as ERAS is applied.In a selected population of young patients fit for surgery, the retroperitoneal surgical approach should be highly taken into account in the therapeutical choice.
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Ciofani et al. (2024) conducted a cohort in Abdominal aortic aneurysms (AAAs) (n=156). Endovascular aneurysm repair (EVAR) vs. Open retroperitoneal repair with ERAS protocol (ORR) was evaluated on All-cause mortality (long-term survival). Endovascular aneurysm repair (EVAR) was associated with significantly worse long-term survival and higher late re-intervention rates (6 vs 0) compared to open retroperitoneal repair with ERAS.
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