This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Outcome of abdominal aortic aneurysm repair in the era of endovascular treatment. BJS 2004; 91: 563-568.
Published: 22nd March 2004
Authors: C. J. Zeebregts, R. H. Geelkerken, J. van der Palen, A. B. Huisman, P. de Smit, R. J. van Det et al.
Background
The effect on outcome of the introduction of endovascular techniques for the exclusion of abdominal aortic aneurysm (AAA) is largely unknown. The aim of the study was to contrast the early and mid‐term outcome after open and endovascular AAA repair.
Method
Consecutive patients who underwent transfemoral endovascular aneurysm repair (EVAR; n = 93) between April 1998 and January 2003, or conventional open aneurysm repair in the time intervals before (n = 113) and after (n = 82) the introduction of EVAR were studied. All data were collected prospectively. All patients underwent elective and primary repair. Patient survival was calculated by the Kaplan–Meier method and the possible predictive value of more than 25 perioperative variables on five outcome variables (length of intensive care unit stay, morbidity, and 30‐day, 6‐month and overall mortality) was assessed by multivariate analysis.
Results
There were no differences in risk profiles between the three groups. Selection for EVAR was based on anatomical grounds only. All five outcome variables were significantly better with EVAR than either former or recent open repair. The only significant predictors of failure were advanced age and the need to perform an additional procedure for former open repair; hypertension and the preoperative use of anticoagulants for recent open repair; and renal insufficiency and pulmonary insufficiency for EVAR.
Conclusion
EVAR offered considerable benefits compared with conventional open repair at early and mid‐term follow‐up, which was not explained by selection of patients with a favourable risk profile. In the current era, in which patients are selected for open repair as a consequence of unfavourable anatomy, morbidity and mortality rates following conventional open treatment of AAA have increased at early and mid‐term, but not at long‐term, follow‐up. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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