Contemporary Analysis of Intact Abdominal Aortic Aneurysm Repair by Treatment Method

Abstract

Introduction: The long-term results of the landmark randomised trials comparing EVAR and open aneurysm repair (OAR) were challenged when recent recommendations of abdominal aortic aneurysm management were being based on them. In the last two decades since those trials were conducted, improvement in perioperative medicine, refined patient selection and advances in graft technology resulted in lower operative mortality. However, the impact of EVAR and OAR on long-term patient survival has been controversial (1, 2). The aim of this study was to compare the outcomes of OAR and EVAR in the recent era. Methods: This was an observational study. Both national administrative and clinical vascular databases were interrogated to capture all patients that underwent a planned AAA repair from the 1st of January 2010 until the 31st of December 2014. The data was matched by using unique patient identifying numbers, and death dates were obtained from national mortality database. Open repair and EVAR using 2nd 3rd generation endografts were included, trial devices and fenestrated/branched configuration were excluded. Logistic regression models were used to determine predictors of 30-day mortality, and Cox proportional hazards model was used to determine predictors of survival. The censoring date for survival analysis was the 31st of January 2018. The national ethics committee approved this study. Results: Overall, 1220 patients underwent aneurysm repair, of which 62 patients were excluded. The mean age was 74 years and 218 (18.2%) patients were females. There were 615 (53.1%) patients on whom an EVAR was performed and the median (interquartile range) AAA diameter was 61 (55-70)mm. The 30-day mortality after OAR and EVAR was 3.5% and 0.7% respectively (adjusted OR: 5.5 [95%CI:1.8-16.4]). The median and maximum follow-up was 4.5 and 8 years respectively. The crude survival curves crossed at 18 months and after adjusting for confounders, EVAR was associated with a HR 1.5 (95%CI:1.2-1.9). Patients who underwent an EVAR had a higher aneurysm-related mortality. Other prognostic factors that were also associated with a lower survival rate were: increased age, being female, and having renal impairment and ischaemic heart disease. Conclusion: In this real world setting using the current endografts devices and technology, patients who underwent EVAR enjoyed a lower short mortality but this benefit disappeared at 2 years follow-up. OAR had a higher survival rate in the long term. Disclosure: Nothing to disclose