Jornal Vascular Brasileiro
Jornal Vascular Brasileiro
Original Article

Early and late results of open surgical and endovascular treatment of infrarenal abdominal aortic aneurysms, selected according to surgical risk

José A. Torres Hernández; Mercedes Sánchez-Barba; Jesús García-Alonso; Magdalena Sancho; José R. González-Porras; Francisco Santiago Lozano Sanchez

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Abstract: Background: Open surgical repair (OSR) and endovascular aneurysm repair (EVAR) surgery are alternative treatments for infrarenal abdominal aortic aneurysm (IRAAA).

Objectives: To compare OSR and EVAR for the treatment of IRAAA.

Methods: 119 patients with IRAAA were electively operated by the same surgeon between January 1, 2006 and December 31, 2015, following selection for OSR or EVAR according to surgical risk. Complications, reinterventions, failures, and early and late mortality were analyzed.

Results: 63 OSR and 56 EVAR patients were analyzed. They were similar in terms of age (70 years), gender (92% men), and average diameter of IRAAA (6.5 cm), but with different comorbidities, surgical risk, and anatomy. EVAR was better than OSR regarding time in the operating theatre (177.5 vs. 233.3 minutes), need for transfusion (25 vs. 73%), and length of stay in ICU (1.3 vs. 3.3 days) and hospital (8.1 vs. 11.1 days). OSR allowed more associated procedures to be conducted simultaneously (19.0 vs. 1.8%). There were no significant differences between the groups with respect to complications (25.4 vs. 25.1%), reinterventions (3.2 vs. 5.2%), or early mortality (1.6 vs. 0%). During follow-up, OSR was associated with fewer revisions (3.13 vs. 4.21), angio-CTs (0.22 vs. 3.23), complications (6.4 vs. 37.5%), reinterventions (3.2 vs. 23.2%), and failures (1.6 vs. 10.7%), and had better survival (78.2 vs. 63.2%).

Conclusions: Correct selection of patients achieves excellent results because it avoids OSR in patients at high risk and avoids EVAR in patients with high anatomical complexity, achieving similar results in the perioperative period, but better results for OSR over the course of follow-up.


abdominal aortic aneurysm, aortic open surgery, endovascular aortic repair


1 Stather PW, Sidloff DA, Rhema IA, Choke E, Bown MJ, Sayers RD. A review of current reporting of abdominal aortic aneurysm mortality and prevalence in the literature. Eur J Vasc Endovasc Surg. 2014;47(3):240-2. PMid:24368205.

2 Creech O Jr. Endo-aneurysmorrhaphy and treatment of aortic aneurysm. Ann Surg. 1966;164(6):935-46. PMid:5332747.

3 Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg. 1991;5(6):491-9. PMid:1837729.

4 Paravastu SC, Jayarajasingam R, Cottam R, Palfreyman SJ, Michaels JA, Thomas SM. Endovascular repair of abdominal aortic aneurysm. Cochrane Database Syst Rev. 2014;23(1):CD004178. PMid:24453068.

5 Brewster DC, Cronenwett JL, Hallett JW Jr, Johnston KW, Krupski WC, Matsumura JS. . Guidelines for the treatment of abdominal aortic aneurysms. J Vasc Surg. 2003;37(5):1106-17. PMid:12756363.

6 Gómez Palonés F, Vaquero Puerta C, Gesto Castromil R, et al. Tratamiento endovascular del aneurisma de aorta abdominal: guía clínica. Angiologia. 2011;63(5):205-28.

7 Thompson M. EVAR update: competitors stake their ground in a high-growth space shift from open to EVAR continues. Medtech Insight. 2013:1-11.

8 Ambler GK, Gohel MS, Mitchell DC, Loftus IM, Boyle JR. The abdominal aortic aneurysm statistically corrected operative risk evaluation (AAA SCORE) for predicting mortality after open and endovascular interventions. J Vasc Surg. 2015;61(1):35-43. PMid:24985535.

9 Greenhalgh RM, Brown LC, Powell JT, Thompson SG, Epstein D, Sculpher MJ. Endovascular versus open repair of abdominal aortic aneurysm. N Engl J Med. 2010;362(20):1863-71. PMid:20382983.

10 Blankensteijn JD, de Jong SE, Prinssen M, et al. Two-year outcomes after conventional or endovascular repair of abdominal aortic aneurysms. N Engl J Med. 2005;352(23):2398-405. PMid:15944424.

11 Becquemin JP, Pillet JC, Lescalie F, et al. A randomized controlled trial of endovascular aneurysm repair versus open surgery for abdominal aortic aneurysms in low- to moderate-risk patients. J Vasc Surg. 2011;53(5):1167-73.e1. PMid:21276681.

12 Lederle FA, Freischlag JA, Kyriakides TC, et al. Outcomes following endovascular vs open repair of abdominal aortic aneurysm: a randomized trial. JAMA. 2009;302(14):1535-42. PMid:19826022.

13 Powell JT, Sweeting MJ, Ulug P, et al. Meta-analysis of individual-patient data from EVAR-1, DREAM, OVER and ACE trials comparing outcomes of endovascular or open repair for abdominal aortic aneurysm over 5 years. Br J Surg. 2017;104(3):166-78. PMid:28160528.

14 van Marrewijik CJ, Fransen G, Laheij R, Harris PL, Buth J. Is a type II endoleak after EVAR a harbinger of risk? Causes and outcome of open conversion and aneurysm rupture during follow-up. Eur J Vasc Endovasc Surg. 2004;27(2):128-37. PMid:14718893.

15 Millon A, Deelchand A, Feugier P, Chevalier JM, Favre JP. Conversion to open repair after endovascular aneurysm repair: causes and results. A French multicentric study. Eur J Vasc Endovasc Surg. 2009;38(4):429-34. PMid:19589700.

16 Brady AR, Thompson SG, Fowkes FR, Greenhalgh RM, Powell JT. Abdominal aortic aneurysm expansion: risk factors and time intervals for surveillance. Circulation. 2004;110(1):16-21. PMid:15210603.

17 De Leur K, Flu HC, Ho GH, de Groot HG, Veen EJ, van der Laan L. Outcome of elective treatment of abdominal aortic aneurysm in elderly patients. Int J Surg. 2015;15:117-23. PMid:25659364.

18 Adriaensen MEAPM, Bosch JL, Halpern EF, Myriam Hunink MG, Gazelle GS. Elective endovascular versus open surgical repair of abdominal aortic aneurysms: systematic review of short-term results. Radiology. 2002;224(3):739-47. PMid:12202708.

19 Hertzer NR, Mascha EJ, Karafa MT, O’Hara PJ, Krajewski LP, Beven EG. Open infrarenal abdominal aortic aneurysm repair: the Cleveland Clinic experience from 1989 to 1998. J Vasc Surg. 2002;35(6):1145-54. PMid:12042724.

20 Takagi H, Sugimoto M, Kato T, Matsuno Y, Umemoto T. Postoperative incision hernia in patients with abdominal aortic aneurysm and aortoiliac occlusive disease: a systematic review. Eur J Vasc Endovasc Surg. 2007;33(2):177-81. PMid:16934501.

21 Chang RW, Goodney P, Tucker LY, et al. Ten-year results of endovascular abdominal aortic aneurysm repair from a large multicenter registry. J Vasc Surg. 2013;58(2):324-32. PMid:23683376.

22 Mehta M, Sternbach Y, Taggert JB, et al. Long-term outcomes of secondary procedures after endovascular aneurysm repair. J Vasc Surg. 2010;52(6):1442-9. PMid:20724099.

23 Mertens J, Houthoofd S, Daenens K, et al. Long-term results after endovascular abdominal aortic aneurysm repair using the Cook Zenith endograft. J Vasc Surg. 2011;54(1):48-57.e2. PMid:21459545.

24 Patel R, Sweeting MJ, Powell JT, Greenhalgh M. Endovascular versus open repair of abdominal aortic aneurysm in 15-years’ follow-up of the UK endovascular aneurysm repair trial 1 (EVAR trial 1): a randomised controlled trial. Lancet. 2016;388(10058):2366-74. PMid:27743617.

25 Powell JT, Brown LC, Forbes JF, et al. Final 12-year follow-up of surgery versus surveillance in the UK Small Aneurysm Trial. Br J Surg. 2007;94(6):702-8. PMid:17514693.

26 Biancari F, Catania A, D’Andrea V. Elective endovascular vs. open repair for abdominal aortic aneurysm in patients aged 80 years and older: systematic review and meta-analysis. Eur J Vasc Endovasc Surg. 2011;42(5):571-6. PMid:21820922.

27 Wahlgren CM, Malmstedt J. Outcomes of endovascular abdominal aortic aneurysm repair compared with open surgical repair in high-risk patients: results from the Swedish Vascular Registry. J Vasc Surg. 2008;48(6):1382-8. PMid:18829239.

28 Steinmetz E, Abello N, Kretz B, Gauthier E, Bouchot O, Brenot R. Analysis of outcome after using high-risk criteria selection to surgery versus endovascular repair in the modern era of abdominal aortic aneurysm treatment. Eur J Vasc Endovasc Surg. 2010;39(4):403-9. PMid:20060753.

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Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
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