Impacto del tratamiento endovascular en la morbimortalidad por aneurisma de aorta abdominal

Abstract

IntroductionDue to the less invasive nature and good post-operative outcomes of endovascular treatment (EVAR) of abdominal aortic aneurysm (AAA), the number of patients treated by this method has increased. ObjectiveTo evaluate the impact of EVAR on morbidity and mortality in the treatment of AAA. MethodsObservational and retrospective study of patients undergoing elective and emergency EVAR or open surgery (CA) for infrarenal AAA in our centre (January 2007-December 2014). An analysis was carried out on the mortality, early and long-term complications, re-operation for any cause, and due to endoleak in EVAR. An analysis of long-term survival was performed, and CA and EVAR groups were compared using routine biomedical tests. ResultsA total of 286 patients who underwent infrarenal AAA repair were identified, of whom 80.1% (28.3 CA vs. 71.7% EVAR) were elective, and 19.1% emergency (77.2 CA vs. 22.8% EVAR).In patients undergoing elective procedures, a significantly higher mean age (68 vs. 76 years, P<.05), and shorter mean post-operative hospital stay (11 vs. 5 days, P<.05) was observed with EVAR. Thirty-day mortality (4.6 CA vs. 0.6% EVAR, P<.05) and complications (20 CA vs. 7.9% EVAR, P<.05) were lower in EVAR, but the number of re-interventions was higher (1.6 CA vs. 12.2% EVAR, P<.05) during the follow up, with no difference in late mortality (25.8 CA vs. 27.4% EVAR).In emergency procedures, cardiological and respiratory complications were more frequent in the CA group (28.3 CA, and 33.3 vs. 0% EVAR, respectively), with no difference in 30-day (31.8 CA vs. 23.1 EVAR) or late mortality (40 CA vs. 40% EVAR). ConclusionPatients undergoing elective EVAR have a significantly lower 30-day morbidity and mortality than those undergoing CA. On the other hand, the long-term mortality was comparable, with a higher re-intervention rate in EVAR. More cardiorespiratory complications were found in CA than in emergency EVAR, with no difference in 30-day or late mortality.