Will endovascular repair replace open surgery for abdominal aortic aneurysm repair?

Objective To evaluate of the impact of endovascular aneurysm repair on the rate of open surgical repair and on the overall treatment of abdominal aort ic aneurysms (AAAs). Methods All patients with AAA who were treated during two consecutive 40-mo nth periods were reviewed. During the first period, only open surgical repa ir was performed; during the subsequent 40 months, endovascular repair and open surgical repair were treatment options. Results A total of 727 patients with AAA were treated during the entire per iod. During the initial 40 months, 268 patients were treated with open surg ical repair, including 216 infrarenal (81%), 43 complex (16%), and 9 ruptur ed (3%) aortic aneurysms. During the subsequent 40 months, 459 patients wit h AAA were treated (71% increase). There was no significant change in the n umber of patients undergoing open surgical repair and no significant differ ence in the rate of infrarenal (238 [77%]) and complex (51 [16%]) repairs. A total of 353 patients were referred for endovascular repair. Of these, 19 0 (54%) were considered candidates for endovascular repair based on compute d tomography or arteriographic morphologic criteria. Analyzing a subgroup o f 123 patients, the most common primary reasons for ineligibility for endov ascular repair were related to morphology of the neck in 80 patients (65%) and of the iliac arteries in 35 patients (28%). A total of 149 patients und erwent endovascular repair. Of these, the procedure was successful in 147 ( 99%), and 2 (1%) patients underwent surgical conversion. The hospital death rate was 0%, and the 30-day death rate was 1%. During a follow-up period o f 1 to 39 months (mean 12 +/- 9), 21 secondary procedures to treat endoleak (20) or to maintain graft limb patency (1) were performed in 17 patients ( 11%). There were no aneurysm ruptures or aneurysm-related deaths. Conclusions Endovascular repair appears to have augmented treatment options rather than replaced open surgical repair for patients with AAA. Patients who previously were not candidates for repair because of medical comorbidit y may now be safely treated with endovascular repair.