Matched-pair Analysis of Endovascular versus Open Surgical Repair of Abdominal Aortic Aneurysms in Young Patients at Low Risk

Diehm, Nicolas; Tsoukas, Athanassios I.; Katzen, Barry T.; Benenati, James F.; Baum, Samuel; Pena, Constantino; Dick, Florian

doi:10.1016/j.jvir.2007.12.445

« Previous Next »Journal of Vascular and Interventional Radiology
Volume 19, Issue 5 , Pages 645-651, May 2008

Matched-pair Analysis of Endovascular versus Open Surgical Repair of Abdominal Aortic Aneurysms in Young Patients at Low Risk

Nicolas Diehm, MD
- Department of Interventional Radiology, Baptist Cardiac and Vascular Institute, 8900 North Kendall Drive, Miami, Florida, 33176
- Division of Clinical and Interventional Angiology, Swiss Cardiovascular Centre, University Hospital, Bern, Switzerland
- Address correspondence to N.D.
Athanassios I. Tsoukas, MD
- Department of Vascular Surgery, Baptist Cardiac and Vascular Institute, 8900 North Kendall Drive, Miami, Florida, 33176
Barry T. Katzen, MD
- Department of Interventional Radiology, Baptist Cardiac and Vascular Institute, 8900 North Kendall Drive, Miami, Florida, 33176
James F. Benenati, MD
- Department of Interventional Radiology, Baptist Cardiac and Vascular Institute, 8900 North Kendall Drive, Miami, Florida, 33176
Samuel Baum
- Department of Interventional Radiology, Baptist Cardiac and Vascular Institute, 8900 North Kendall Drive, Miami, Florida, 33176
Constantino Pena, MD
- Department of Interventional Radiology, Baptist Cardiac and Vascular Institute, 8900 North Kendall Drive, Miami, Florida, 33176
Florian Dick, MD
- Department of Cardiovascular Surgery, Swiss Cardiovascular Centre, University Hospital, Bern, Switzerland.

Received 12 August 2007; received in revised form 11 December 2007; accepted 17 December 2007. published online 14 March 2008.

Purpose

To compare clinical outcomes of endovascular and open aortic repair of abdominal aortic aneurysms (AAAs) in young patients at low risk. It was hypothesized that endovascular aneurysm repair (EVAR) compares favorably with open aneurysm repair (OAR) in these patients.

Materials and Methods

Twenty-five patients aged 65 years or younger with a low perioperative surgical risk profile underwent EVAR at a single institution between April 1994 and May 2007 (23 men; mean age, 62 years ± 2.8). A sex- and risk-matched control group of 25 consecutive patients aged 65 years or younger who underwent OAR was used as a control group (23 men; mean age, 59 years ± 3.9). Patient outcomes and complications were classified according to Society of Vascular Surgery/International Society for Cardiovascular Surgery reporting standards.

Results

Mean follow-up times were 7.1 years ± 3.2 after EVAR and 5.9 years ± 1.8 after OAR (P = .1020). Total complication rates were 20% after EVAR and 52% after OAR (P = .0378), and all complications were mild or moderate. Mean intensive care unit times were 0.2 days ± 0.4 after EVAR and 1.1 days ± 0.4 after OAR (P < .0001) and mean lengths of hospital stay were 2.3 days ± 1.0 after EVAR and 5.0 days ± 2.1 after OAR (P < .0001). Cumulative rates of long-term patient survival did not differ between EVAR and OAR (P = .144). No AAA-related deaths or aortoiliac ruptures occurred during follow-up for EVAR and OAR. In addition, no surgical conversions were necessary in EVAR recipients. Cumulative rates of freedom from secondary procedures were not significantly different between the EVAR and OAR groups (P = .418). Within a multivariable Cox proportional-hazards analysis adjusted for patient age, maximum AAA diameter, and cardiac risk score, all-cause mortality rates (odds ratio [OR], 0.125; 95% CI, 0.010–1.493; P = .100) and need for secondary procedures (OR, 5.014; 95% CI, 0.325–77.410; P = .537) were not different between EVAR and OAR.