HISTORIC CONTROL COMPARISON OF OUTCOME FOR MATCHED GROUPS OF PATIENTSUNDERGOING ENDOLUMINAL VERSUS OPEN REPAIR OF ABDOMINAL AORTIC-ANEURYSMS

Purpose: Currently no randomized studies show the relative morbidity a nd mortality of the open and endoluminal methods of abdominal aortic a neurysm (AAA) repair. The aim of this study was to analyze the outcome of two matched groups of patients with AAA, one undergoing open repai r and the other undergoing endoluminal repair. Methods: Two groups of patients who had undergone repair of AAA by open technique (group 1) o r by endoluminal methods (group 2) were compared. A historic control c ohort of 27 patients was selected from 56 consecutive patients who und erwent open repair of AAA between January 1991 and February 1992. Pati ents considered unsuitable for the endoluminal method on the basis of computed tomography and aortography were excluded (n = 29). Between Ma y 1992 and November 1994 prospective data were recorded for 62 consecu tive patients who underwent endoluminal repair by tube or bifurcated e ndografts. Twenty-eight patients who had been specifically referred fo r endoluminal AAA repairs because of preexisting severe medical comorb idities were excluded. Six of the endoluminal cases had failure, requi ring conversion to open operation, and were excluded for separate anal ysis, leaving 28 patients in group 2. Patients in both groups were thu s fit and suitable for either open or endoluminal repair and were comp arable in relation to age, sex, risk factors, dimensions, and form of AAA. Results: The mean values for operation time, blood loss, intensiv e care stay, and hospital stay for group 1 and group 2 were 2.6 versus 3.1 hours, 1422 versus 873 ml, 1.8 versus 0.7 days,* and 12.4 versus 11.1 days, respectively (p < 0.05). Local/vascular complications occ urred in 15% of patients in group 1 compared with 25% in group 2 (p = 0.55), whereas remote/systemic complications occurred in 37% and 29%, respectively (p = 0.3). Five of 28 patients in the endoluminal group h ad complications requiring early operative repair (n = 3) or late revi sion (n = 2). When comparison was made on an intention-to-treat basis (with failed procedures included), the incidence of local/vascular com plications was significantly greater for endoluminal repair (p = 0.047 ). Conclusions: The incidence of systemic/remote complications was sim ilar for the two groups in spite of significantly less blood loss and shorter intensive care unit stay with endoluminal repair. The incidenc e of local/vascular complications had a tendency to be higher for endo luminal compared with standard open method (and was significantly grea ter if failed procedures were included). In this early experience with prototype devices, patients who were medically suitable for open surg ical procedures did not derive benefit from the less invasive endolumi nal technique with respect to duration of operation, length of hospita l stay, or perioperative morbidity and mortality. On the other hand, b ecause they also did not have worse outcome, a randomized study is now justified in this group.