Five-year survival after elective open and endovascular aortic aneurysm repair

Jüri Lieberg; Karl G Kadatski; Mart Kals; Kaido Paapstel; Jaak Kals

doi:10.1177/14574969211048707

Five-year survival after elective open and endovascular aortic aneurysm repair

Scand J Surg. 2022 Jan-Mar;111(1):14574969211048707. doi: 10.1177/14574969211048707. Epub 2021 Nov 14.

Authors

Jüri Lieberg¹, Karl G Kadatski², Mart Kals³, Kaido Paapstel⁴, Jaak Kals⁵

Affiliations

¹ Department of Vascular Surgery, Tartu University Hospital, Tartu, Estonia Department of Surgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.
² Medical Faculty, University of Tartu, Tartu, Estonia.
³ Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia Institute for Molecular Medicine Finland, FIMM, HiLIFE, University of Helsinki, Helsinki, Finland.
⁴ Department of Cardiology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.
⁵ Department of Surgery, Institute of Clinical Medicine, University of Tartu, 8 Puusepa Street, Tartu 51014, Estonia Department of Vascular Surgery, Tartu University Hospital, Tartu, Estonia.

PMID: 34779283
DOI: 10.1177/14574969211048707

Abstract

Background and objective: Current evidence suggests short-term survival benefit from endovascular aneurysm repair (EVAR) versus open surgical repair (OSR) in elective abdominal aortic aneurysm (AAA) procedures, but this benefit is lost during long-term follow-up. The aim of this study was to compare short- and mid-term all-cause mortality in patients with non-ruptured aneurysm treated by OSR and EVAR; and to assess the rate of complications and reinterventions, as well as to evaluate their impact on survival.

Methods: The medical records of the non-ruptured AAA patients undergoing OSR or EVAR between 1 January 2011 and 31 December 2019 at Tartu University Hospital, Estonia, were retrospectively reviewed. We gathered survival data from the national registry (mean follow-up period was 3.7 ± 2.3 years).

Results: A total of 225 non-ruptured AAA patients were treated operatively out of whom 95 (42.2%) were EVAR and 130 (57.8%) were OSR procedures. The difference in estimated all-cause mortality between the OSR and EVAR groups at day 30 was statistically irrelevant (2.3% vs 0%; p = 0.140), but OSR patients showed statistically significantly higher 5 year survival compared with EVAR patients (75.3% vs 50.0%, p = 0.002). Complication and reintervention rates for the EVAR and OSR groups did not differ statistically (26.3% vs 16.9%, p = 0.122; 10.5% vs 11.5%, p = 0.981, respectively). Multivariate analysis revealed that greater aneurysm diameter (p = 0.012), EVAR procedure (p = 0.016), male gender (p = 0.023), and cerebrovascular diseases (p = 0.028) were independently positively associated with 5-year mortality.

Conclusions: Thirty-day mortality, and complication and reintervention rates for EVAR and OSR after elective AAA repair were similar. Although the EVAR procedure is an independent risk factor for 5-year mortality, higher age and greater proportion of comorbidities among EVAR patients may influence not only the choice of treatment modality, but also prognosis.

Keywords: Abdominal aortic aneurysm; complications; endovascular aneurysm repair; open surgical repair; survival.

MeSH terms

Aortic Aneurysm, Abdominal* / surgery
Blood Vessel Prosthesis Implantation*
Elective Surgical Procedures / methods
Endovascular Procedures* / methods
Humans
Male
Postoperative Complications / epidemiology
Postoperative Complications / surgery
Retrospective Studies
Risk Factors
Treatment Outcome