Improved survival after endoluminal repair with second-generation prostheses compared with open repair in the treatment of abdominal aortic aneurysms: A 5-year concurrent comparison using life table method

Purpose: The aim of this study was to compare the outcome of consecutive pa tients with abdominal aortic aneurysm (AAA) treated concurrently by means o f open repair (OR) and endoluminal repair (ER) with second-generation prost heses by the same surgeons during a defined interval. Methods: Between May 1995 and December 1998 second-generation (low profile, fully supported, modular) endoprostheses were implanted in 148 patients. T hese patients, together with 135 patients treated concurrently with OR duri ng the same period, comprised the study group of 283 patients. Patient sele ction was based on aneurysm morphology. Those patients who were anatomicall y suitable for ER were treated with this method. The ER and OR groups were similar with regard to age, sex, and size of AAA. The ER group contained hi gh-risk patients considered unfit for OR (n = 46), and the OR group contain ed high-risk patients who were anatomically unsuitable for ER (n = 19). Out come criteria in both groups were survival and successful aneurysm repair. Success in the ER group was defined as exclusion of the aneurysm sac and st ability or reduction in AAA maximum transverse diameter. Persistent endolea ks were classified as failures, regardless of whether they were subsequentl y corrected with secondary endovascular intervention. Data were analyzed wi th the Life table method. The minimum period of follow-up for all patients was 18 months. Results: The perioperative mortality rate was 5.9% in the OR group and 2.7% in the ER group (not significant). There was a statistically significant d ifference between the survival curves of the two groups in favor of the ER group when analyzed with the log-rank test (P = .004). The Kaplan-Meier cur ve for graft failure for the ER group revealed a 3-year graft success proba bility of 82%. Survival probability with successful repair in the OR group at 3 years was 85%. Conclusions: A concurrent comparison of ER with second-generation prosthese s versus OR demonstrated a significant difference in survival in favor of t he ER group. The probability of survival with successful repair at 3 years was similar in both groups.