Durability and Survival Are Similar Following Elective Endovascular and Open Repair of Abdominal Aortic Aneurysms in Younger Patients

Abstract

The role of endovascular aneurysm repair (EVAR) in young patients is controversial. The purpose of this study was to determine the long-term outcomes and reintervention rates in patients aged ≤60 years who underwent elective open or EVAR of an abdominal aortic aneurysm. All patients aged ≤60 years who underwent elective abdominal aortic aneurysm repair between 2000 and 2013 were identified during a retrospective review of our center’s prospectively maintained database. Preoperative anatomic measurements were performed and compared with endografts’ instructions for use (IFU) criteria. A total of 169 patients aged ≤60 years (mean age, 56.7 ± 2.8 years) underwent elective repair (119 open, 50 EVAR). Patients treated with open repair and EVAR had similar comorbidities, except EVAR patients were more likely to have hypertension (P = .03) and poor left ventricular function (P = .04). The open repair group had significantly more angulated suprarenal (P = .004) and infrarenal neck angles (P = .005), shorter neck lengths (P < .001) and larger maximal aneurysm diameter (P = .015) compared with the EVAR group. Only five patients (10%) in the EVAR group did not meet all IFU criteria. The overall in-hospital mortality rate was 1.8% (0% EVAR, 2.5% open, P = .56). Overall mean life expectancy was 11.5 years (9.8 years EVAR, 11.9 years; P = .09). One-year (98% EVAR, 96% open), 5-year (86% EVAR, 88% open), and 10-year (54% EVAR, 75% open) survival did not differ between EVAR and open (P = .16). Long-term survival (78% EVAR, 85.1% open; P = .09) and reintervention rates (12% EVAR, 15.8% open; P = .805) did not differ. No late aneurysm rupture or aneurysm-related deaths were observed. The most common causes of long-term mortality were malignancy and cardiovascular events. Reinterventions in the open group were exclusively access related (incisional hernia repairs), whereas all reinterventions in the EVAR group were aortic related, including one conversion to open repair. With adherence to IFU criteria, EVAR results in similar durability and long-term survival compared with open repair in young patients aged ≤60 years. Long-term mortality in these young patients is related to malignancy and cardiovascular events, not aortic events or reinterventions.