Endoluminal graft repair for abdominal aortic aneurysms in high-risk patients and octogenarians - Is it better than open repair?

Objective To analyze the short-term and midterm results of open and endolum inal repair of abdominal aortic aneurysms (AAA) in a large single-center se ries and specifically in octogenarians. Methods Between January 1997 and October 2000, 470 consecutive patients und erwent elective repair of AAA. Conventional open repair (COR) was performed in 210 patients and endoluminal graft (ELG) repair in 260 patients. Ninety of the patients were 80 years of age or older; of these, 38 underwent COR and 52 ELG repair. Results Patient characteristics and risk factors were similar for both the entire series and the subgroup of patients 80 years or older. The overall c omplication rate was reduced by 70% or more in the ELG versus the COR group s. The postoperative death rate was similar for the COR and ELG groups in t he entire series and lower (but not significantly) in the ELG 80 years or o lder subgroup versus the COR group. The 36-month rates of freedom from endo leaks, surgical conversion, and secondary intervention were 81%, 98.2%, and 88%, respectively. Conclusion The short-term and midterm results of AAA repair by COR or ELG a re similar. The death rate associated with this new technique is low and co mparable, whereas the complication rate associated with COR in all patients and those 80 years or older in particular is greater and more serious than ELG repair. Long-term results will establish the role of ELG repair of AAA , especially in elderly and high-risk patients.