Open or Endovascular Abdominal Aortic Aneurysm-which is better?

Endovascular aneurysm repair is associated with a significant reduction in perioperative mortality and morbidity compared with open aneurysm repair in the treatment of abdominal aortic aneurysm. However, this benefit decreases over time owing to increased reinterventions and late aneurysm rupture after endovascular repair. This is in accordance to a new study published in JAMA Network Open.

The study is a multicenter retrospective cohort study. The patients undergoing first-time elective endovascular or open abdominal aortic aneurysm repair were included. Patients with ruptured abdominal aortic aneurysm, concomitant procedures, or prior history of abdominal aortic aneurysm repair, were excluded.

Among a total of 32 760 patients who underwent surgical abdominal aortic aneurysm repair, 28 281 patients underwent endovascular repair and 4479 patients underwent open repair.

The results showed that open repair was associated with significantly lower 6-year mortality compared with endovascular repair with increases in mortality starting from 1 to 2 years and 2 to 6 years. Hence, it was concluded that overall mortality after elective abdominal aortic aneurysm repair was higher with endovascular repair than open repair despite reduced 30-day mortality and perioperative morbidity after endovascular repair. Endovascular repair additionally was associated with significantly higher rates of long-term rupture and reintervention.

These findings emphasize the importance of careful patient selection and long-term follow-up surveillance for patients who undergo endovascular repair.