Long-term Efficacy of EVAR in Patients Aged Less Than 65 Years with an Infrarenal Abdominal Aortic Aneurysm and Favorable Anatomy

Abstract

The aim of this study was to compare early and long-term outcomes of endovascular aneurysm repair (EVAR) versus open surgical repair (OSR) in patients aged ≤65 years. Data of patients aged ≤65years undergoing infrarenal abdominal aortic aneurysm repair, between 2005 and 2013, were retrospectively reviewed. All EVAR procedures were performed according to the instruction for use, and only OSR procedures with an infrarenal aortic cross-clamping were included in the study. In this group of 115 patients (EVAR: 58 patients, 51% and OSR: 57 patients, 49%), EVAR and OSR patients had similar comorbidities, except for obesity (EVAR: 38% vs. OSR: 19%; P=0.03). A stay in the intensive care unit (ICU) was necessary in 19% of patients with EVAR versus 79% with OSR (P=0.001), and the amount of blood transfusion was 236±31mL for EVAR versus 744±98mL for OSR (P=0.001). The hospital stay was 4±2days for EVAR versus 9±6days for OSR (P=0.03). The overall 30-day mortality was 1% (EVAR: 0% vs. OSR: 2%; P=0.30). Five patients (4%) required reinterventions within 30 days (EVAR: 0% vs. OSR: 8%, P=0.001). The mean follow-up was 86±38months. Freedom from reintervention at 10years after EVAR was 81% versus OSR 74%; (P=0.77). Late reinterventions were reported in 13 patients (23%) with OSR and in 10 patients (17%) with EVAR. Postoperative retrograde ejaculation occurred more often in patients with OSR (31%) versus EVAR (2%) (P=0.001). During the follow-up, cancer was found in 19 (17%) patients with no difference between EVAR and OSR (P=0.83). The global survival at 10years was 72% (EVAR: 79% vs. OSR: 70%; P=0.94). In this study, EVAR was associated with a shorter hospital stay, less need for the ICU, and less early reinterventions than OSR. Survival and reinterventions during the follow-up were not significantly different between EVAR and OSR. According to theseresults, EVAR may be considered for patients aged ≤65years with a favorable anatomy.