Outcomes of Asymptomatic Abdominal Aortic Aneurysm as Compared between Open Aortic Repair and Endovascular Aneurysm Repair
Khamin Chinsakchai MD*, Wannapa Phetpoonpipat MD*, Chanean Ruangsetakit MD*, Chumpol Wongwanit MD*, Pramook Mutirangura MD*, Nuttawut Sermsathanasawadi MD, PhD*, Kiattisak Hongku MD*, Suteekanit Hahtapornsawan MD*
Affiliation : * Division of Vascular Surgery, Department of Surgery, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : Endovascular aneurysm repair (EVAR) is less invasive than open aortic repair for treatment of abdominal
aortic aneurysm (AAA).
Objective : To investigate the outcomes of EVAR and open aortic repair among patients with asymptomatic AAA.
Material and Method: We retrospectively reviewed consecutive, asymptomatic, AAA patients who have undergone either a
conventional open aortic repair procedure or an EVAR from January 2007 to December 2011. The primary endpoint of our
investigation was perioperative mortality. Secondary endpoints included procedural details, perioperative adverse events,
intensive care unit (ICU) stays, hospital stays, re-intervention and survival rate during five years of follow-up.
Results : Among 147 patients, 77 patients were treated with the open aortic repair method and 70 patients were treated with
an EVAR. Mean age of the EVAR group (75.21+7.7 years) was higher than the open aortic repair group (69.14+8.7 years),
(p<0.01). In addition, the EVAR group was made up of more unfit patients (58.4%) than the open aortic repair group
(34.3%), p = 0.07. The perioperative mortality rate for the open aortic repair group was 2.9% as compared to 0% in the
EVAR group (p = 0.225). Patients in the EVAR group experienced statistical advantages in the reduction of operative time,
blood loss and blood replacement as compared with the open aortic repair group (p<0.01). In addition, EVAR patients also
experienced a decrease in ICU and hospital stays as compared to open aortic repair patients (p<0.01). There were minimal
statistical differences between the two groups in terms of perioperative complications (EVAR 40.3% vs. open repair 30.4%,
p = 0.265), perioperative re-intervention (EVAR 7.8% vs. open repair 2.9%, p = 0.28) and late re-intervention (EVAR 10.4%
vs. open aortic repair 4.3%, p = 0.28). However, as for the cumulative survival rate at five years, the EVAR group was 54%
as compared with 80% in the open aortic repair group (p<0.05).
Conclusion : Endovascular treatment (EVAR) for asymptomatic AAA has a decrease in operative details as well as ICU and
hospital stays as compared with an open aortic repair procedure. In spite of the fact that the EVAR group included more unfit
patients than open aortic repair group, our reviewed data showed minimal statistical significance in terms of perioperative
mortality and re-intervention rates as compared with the open aortic repair group.
Keywords : Asymptomatic abdominal aortic aneurysm, Open aortic repair, Endovascular aneurysm repair
