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Long-Term Outcomes of Abdominal Aortic Aneurysm Repair

In a large observational study, patients treated with endovascular repair fared no worse than those treated with open surgical repair.

Introduced in 1991, endovascular approaches for abdominal aortic aneurysm (AAA) surgery now account for more than 40% of elective repairs. Randomized trials have indicated that the endovascular method is associated with lower perioperative mortality and fewer complications than open surgical repair, but long-term outcomes have not been thoroughly assessed. To address this issue, investigators used administrative claims data to evaluate elective AAA repair among Medicare beneficiaries during the period 2001 to 2004. They used propensity scores derived from predictors of the endovascular approach to create matched cohorts of 22,830 patients each.

Perioperative mortality was higher with the open approach than with the endovascular approach (4.8% vs. 1.2%; relative risk, 4.00; P<0.001), and the relative perioperative mortality risk was similar across age groups. This survival advantage persisted longer than 4 years in patients aged 85 (but not in those aged <85). Rupture within 4 years after repair occurred rarely with both procedures but was more common in patients treated with the endovascular approach than in those treated with the open approach (1.8% vs. 0.5%, P<0.001), as were reinterventions related to AAA (9.0% vs. 1.7%, P<0.001). Laparotomy-related reinterventions by year 4 were more common in patients treated with open surgical repair than in those treated with endovascular repair (9.7% versus 4.1%, P<0.001).

Comment: These results demonstrate many of the trade-offs between an endovascular and an open approach to the repair of an abdominal aortic aneurysm. Short-term results favored the endovascular approach, and its mortality advantage over time was sustained in patients aged 85 years or older. The profiles of late complications differ with the two approaches; the endovascular approach avoids the laparotomy-related complications of open surgical repair, but these results suggest that it is associated with a higher risk for problems related to the aneurysm repair.

— Harlan M. Krumholz, MD, SM

Published in Journal Watch Cardiology January 30, 2008

Citation(s):

Schermerhorn ML et al. Endovascular vs. open repair of abdominal aortic aneurysms in the Medicare population. N Engl J Med 2008 Jan 31; 358:464.

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