The Impact of Endovascular Aneurysm Repair on the Early Outcome of Aortic Aneurysm Repair

Objective: The introduction of endovascular abdominal aortic aneurysm repair (EVAR) offered patients with infrarenal abdominal aortic aneurysm (AAA) a less invasive treatment option. The objective of this study is to evaluate the impact of EVAR on the overall outcome of surgical treament of AAA. Methods: This is a retrospective study of 144 consecutive patients over a 2 years period who presented with large AAAs.* Patients were offered EVAR if they had suitable anatomy (55 patients -38%), the remaining 89 patients had open repair (OR). All patients were evaluated by computed tomography with intravenous contrast except for those with chronic renal insufficiency (CRI). The average age was higher in the EVAR group (77 vs., 72), and more females were in the OR group. (42% Vs 34%). Results: The 30 day operative mortality was higher in the OR group (2.2% vs., zero% ). Morbidities in the OR group included 2 wound dehiscences (2.2%), one colon ischemia requiring resection (1.1%) and one acute renal failure requiring hemodialysis (1.1%). In the EVAR group there was one conversion to open repair (1.8%) and 2 graft limb occlusion (3.6%). The endoleak rate was 18.2% (10 patients). Secondary interventions were needed in 4 patients (12.7 %). There were no cases of rupture during the follow-up period of 18 months. The overall mortality of AAA repair was 1.4%. Conclusion: The use of EVAR selectively in AAA patients has decreased the operative mortality compared to other reports. EVAR patients however require close follow-up with more secondary interventions. *These cases were performed at the department of Vascular Surgery at Geisinger Medical Center (100 North Academy Ave, Danville, PA, USA) in the period from 8/1/2004 to 8/1/2006. The author is one of four partners who performed these procedures.