Abdominal aortic aneurysm - A 6-year comparison of endovascular versus transabdominal repair

Objective To test the hypothesis that endovascular repair of abdominal aortic aneurys m (AAA) will result in a significant reduction in mortality and morbidity r ates and cost when compared with open transabdominal repair. Summary Backgr ound Data Since the introduction of endovascular repair of AAA this decade, multiple groups have evaluated different endovascular grafts. Despite the excellent results reported initially, there has been a paucity of well-controlled, co mparative studies looking at long-term outcome. Methods From 1992 to 1998, the first 100 consecutive patients undergoing endovascul ar AAA repair (mean age 74.7, AAA size 5.6 cm) were compared to 100 patient s undergoing transabdominal repair (mean age 72.9, AAA size 5.9 cm). All pa tients undergoing endovascular repair received a device manufactured by End ovascular Technologies, Inc. (Menlo Park, CA) and were prospectively follow ed with periodic examination, contrast-enhanced computed tomography, and du plex scanning. Of the 200 patients, 198 have been available for long-term f ollow-up. Results The two groups had similar preoperative risk factors. Surgical time (211 vs . 256 minutes, p < 0.005), blood loss (328 vs. 1010 ml, p < 0.005), and blo od replacement (0.4 vs. 1.6 units, p < 0.005) were all decreased in the end ovascular group. Median intensive care unit stay (0 vs. 2 days) and hospita l slay (2 vs. 7 days) were significantly reduced in the endovascular group. insignificant trends in lower morbidity rates (myocardial infarction 1% vs . 5%, respiratory failure 1% vs. 5%, colon ischemia 0% vs. 2%) were present in patients undergoing endovascular repair. This led to decreased hospital cost and increased hospital profit. The surgical mortality rate (2% vs. 3% ) and 5-year survival rate (65% vs. 72%) have been equivalent between the t wo groups, Conclusions The surgical mortality rate is low for both groups and not statistically di fferent. Endovascular repair significantly reduces resource utilization (su rgical time, blood replacement, intensive care unit and hospital stay) and cost when compared to transabdominal aneurysm repair. Long-term survival is equivalent in patients undergoing AAA repair regardless of technique. Alth ough endovascular repair appears durable for up to 6 years, longer follow-u p studies are warranted.