Does the wide application of endovascular AAA repair affect the results of open surgery?

Purpose: to examine the effect of the adoption of endovascular aneurysm repair (EVAR) on the outcome of open repair (OR). Methods: between May 1998 and December 2001, EVAR (Zenith) was performed in 117 patients, and OR was performed because of anatomic restrictions in 40 (group A), and because of young age in 11 patients (group 13). Results: EVAR patients had higher ASA classifications (p < 0.0001). EVAR was associated with a 98.3% (115 patients) technical success rate, one conversion to OR and one fatal cardiac arrest. Thirty-day mortality was 2.6% (3 patients) in EVAR, 15% (6 patients) in group A and none in group B. There was no difference in late survival between the three groups. Late reinterventions, mainly endovascular, were more frequent in EVAR. At a median follow-up of 17 months one stent-graft had migrated 5 mm distally and five stents had fractured, but without clinical consequence. Conclusions: EVAR provides good results even with inclusion of high-risk patients. The adoption of EVAR may adversely affect the results of OR offered to patients because of anatomic considerations. However, OR continues to be the first option for low-risk young patients.