Midterm survival after endovascular versus open repair of infrarenal aortic aneurysms

Purpose: To report the midterm survival after endovascular repair (ER) of infrarenal aortic aneurysms and to compare the outcomes to contemporaneous patients treated with open repair (OR). Methods: Between January 1995 and December 2001, 498 patients were treated for abdominal aortic aneurysm: 289 (52%) underwent OR and 209 (48%) underwent ER at a single center. Preoperative risk factors were graded according to the SVS/AAVS risk stratification. A computerized database was used to record demographic, clinical, and follow-up data. Results: Significant benefits (p<0.0001) were observed in the ER group in terms of mean procedural time (163 +/- 66 versus 132 +/- 61 minutes), mean blood loss (1268 +/- 923 versus 122.5 +/- 284 mL), and mean hospital length of stay (16.24 +/- 13.3 versus 9.3 +/- 11.6 days). The perioperative mortality for OR and ER patients were, respectively, 5.1% and 1.5% (p=0.04). The mean follow-up was 40 months in the OR group (range 0-85) and 19 months in the ER group (range 2-80). Contact was lost with 31 (6%) patients during the study. No overall survival advantage was observed for OR over ER, and comparison of OR and ER according the risk classifications did not yield any significant differences. No patients died of aneurysm rupture, but 7 ER patients had to be converted to open surgery. The cumulative freedoms from reinterventions at 4 years for the OR and ER groups, respectively, were 87% and 63% (p=0.001). Patients treated by OR had better clinical success (p=0.001). Patients in the ER group without iliac artery aneurysm showed a significant improvement (p=0.035) over patients with aneurysmal iliac arteries. Conclusions: Over the 7 years of this study, ER realized its goal: prevention of aneurysm rupture. Despite a greater number of reinterventions for ER patients, no overall survival difference was observed.