Endovascular Aortic Repair (EVAR) Offers Safe, Durable, and Effective Alternative to Open Aortic Repair (OAR) for Abdominal Aortic Aneurysms

The objective of a recent study was to compare outcomes for endovascular (EVAR) and open aortic repair (OAR) of abdominal aortic aneurysms (AAAs) in low-risk patients aged <=65 years.

EVAR has been shown to have shorter ICU stays and length of stay when compared with OAR. This study, published in the Journal of Vascular and Interventional Radiology, shows favorable preliminary long-term data for the durability and safety of EVAR when compared with OAR for aortic abdominal aneurysm.

Methodology
Patients undergoing Endovascular Aortic Repair were treated with a variety of grafts such as the EVT, Zenith, Excluder, and Ancure, to name a few.

Patients having Open Aortic Repair were treated with the surgical insertion of a Dacron prosthesis.

Data were evaluated for a primary end point of all-cause mortality.

Data were also evaluated for abdominal aortic aneurysms-related death, 30-day complication rate, transfusion rate, need for repeat AAA-related procedures, and length of stay. The mean follow-up times were 7.1 years after EVAR and 5.9 years after OAR.

Results
Patients who underwent EVAR were slightly older, but had better overall risk scores than those who underwent OAR.

After 30 days, there was a complication rate of 20% for EVAR versus a 52% complication rate for OAR, but these complications were mild/moderate. No patient died or had aortic rupture in either group.

The statistically significant difference between the 2 groups was the ICU stay and the total length of stay in the hospital.

Mean ICU stay for the EVAR patients was 0.2 days versus 1.1 days for OAR patients, and mean length of stay for EVAR was 2.3 days versus 5.0 days for OAR.

Conclusions/Discussion
When the short-term outcomes were evaluated, there was a statistically significant decrease in ICU and total hospital length of stay in the EVAR group. This fact correlates well with previous studies on short-term efficacy.

There are many confounding factors in evaluating the long-term durability of EVAR in young patients, such as the evolving technical improvements in endografts.

Researchers are resigned to prospectively study populations that have had yesterday’s grafts with yesterday’s expertise.

As stated by the authors of this study, “the comparatively lower risk of OAR may not justify the exposure (of these young patients) to the unknown late complications of EVAR.”

Therefore, in this study, researchers were pleased to find no statistically significant difference in long-term outcomes between the EVAR and OAR groups of patients evaluated in this study, which included a mean follow-up of 7+ years for the EVAR group.

In conclusion, the authors recommend that, in young patients with low OAR operative risks, both the doctor and patient must weigh the benefits of the well-understood risks of OAR to the unknown late risks of EVAR.

Reviewer’s Comments
The results in this and other ongoing studies like it are promising that EVAR will prove just as safe, durable, and effective as OAR.

Author: Sharon Gonzales, MD
Reference:
Diehm N, Tsoukas AI, et al. Matched-Pair Analysis of Endovascular versus Open Surgical Repair of Abdominal Aortic Aneurysms in Young Patients at Low Risk. J Vasc Interv Radiol; 2008; 19 (May): 645-651