Abdominal aortic aneurysm repair: long-term follow-up of endovascular versus open repair

作者：Piffaretti Gabriele^*; Mariscalco Giovanni; Riva Francesca; Fontana Federico; Carrafiello Gianpaolo; Castelli Patrizio

来源：Archives of Medical Science, 2014, 10(2): 273-282.

DOI：10.5114/aoms.2014.42579

• abdominal aortic aneurysms
• long-term results
• aneurysm mortality

Introduction: To compare early and long-term outcomes of endovascular abdominal aortic aneurysm repair (EVAR) versus open repair (OPEN). Design: Prospective observational, per protocol, non-randomized, with retrospective analyses. %26lt;br%26gt;Material and methods: Between 2000 and 2005, a total of 311 patients having EVAR or OPEN repair of infrarenal abdominal aortic aneurysms were identified and included in this prospective single-center observational study. A propensity score-based optimal-matching algorithm was employed, and 138 patients undergoing EVAR procedures were matched (1: 1) to OPEN repair. %26lt;br%26gt;Results: Open repair showed higher hospital mortality (17% vs. 6%, p = 0.004), respiratory failure (p %26lt; 0.026), transfusion requirement (p %26lt; 0.001), and intensive care unit admission (27% vs. 7%, p %26lt; 0.001), and longer hospitalization (p %26lt; 0.001). Median follow-up was 70 months (25th to 75th percentile, 24 to 101). Actuarial survival estimates at 1, 5 and 10 years were 93%, 74%, 49% for the OPEN group compared to 89%, 69%, 59% for the EVAR group (p = 0.465). A significant difference between groups was observed in younger patients (%26lt; 75 years) only (p %26lt; 0.044). Late complication and re-intervention rates were significantly higher in EVAR patients (p %26lt; 0.001 and p = 0.002, respectively). Freedom from late complications at 1, 5 and 10 years was 96%, 92%, 86%, and 84%, 70%, 64% for OPEN and EVAR procedures, respectively. %26lt;br%26gt;Conclusions: Our experience confirms the excellent results of the EVAR procedures, offering excellent early and long-term results in terms of safety and reduction of mortality. Patients %26lt; 75 years seem to benefit from EVAR not only in the immediate postoperative period but even in a long-term perspective.

• 出版日期2014-4