Key result
Endovascular repair of abdominal aortic aneurysms was associated with a non-significant reduction in overall mortality compared to open repair (7.69% vs 11.89%, RR 0.647, p=0.263).
Why the study?
Does endovascular repair reduce mortality and morbidity compared to open repair in patients with abdominal aortic aneurysm across different physiologic risk classes?
Cross-Sectional (n=377)
No
Does endovascular repair reduce mortality and morbidity compared to open repair in patients with abdominal aortic aneurysm across different physiologic risk classes?
Relative Risk: 0.647
Absolute Event Rate: 7.69% vs 11.89%
p-value: p=0.263
EVAR presents better short-term outcomes than open repair across all classes of physiologic risk, suggesting open repair should be reserved for young, healthy patients with very low risk of adverse events.
INTRODUCTION: Endovascular repair (EVAR) of abdominal aortic aneurysm has become the standard of care due to a lower 30-day mortality, a lower morbidity, shorter hospital stay and a quicker recovery. The role of open repair (OR) and to whom this type of operation should be offered is subject to discussion. OBJECTIVE: To present a single center experience on the repair of abdominal aortic aneurysm, comparing the results of open and endovascular repairs. METHODS: Retrospective cross-sectional observational study including 286 patients submitted to OR and 91 patients submitted to EVAR. The mean follow-up for the OR group was 66 months and for the EVAR group was 39 months. RESULTS: The overall mortality was 11.89% for OR and 7.69% for EVAR (P=0.263), EVAR presented a death relative risk of 0.647. It was also found a lower intraoperative bleeding for EVAR (OR=1417.48±1180.42 mL versus EVAR=597.80±488.81 mL, P<0.0002) and a shorter operative time for endovascular repair (OR=4.40±1.08 hours versus EVAR=3.58±1.26 hours,P<0.003). The postoperative complications presented no statistical difference between groups (OR=29.03% versus EVAR=25.27%, P=0.35). CONCLUSION: EVAR presents a better short term outcome than OR in all classes of physiologic risk. In order to train future vascular surgeons on OR, only young and healthy patients, who carry a very low risk of adverse events, should be selected, aiming at the long term durability of the procedure.
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Menezes et al. (2016) conducted a cross-sectional in Abdominal aortic aneurysm (n=377). Endovascular repair (EVAR) vs. Open repair (OR) was evaluated on Overall mortality (RR 0.647, p=0.263). Endovascular repair of abdominal aortic aneurysms was associated with a non-significant reduction in overall mortality compared to open repair (7.69% vs 11.89%, RR 0.647, p=0.263).
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