The Justification of Open Surgical Repair for an Abdominal Aortic Aneurysm: A Retrospective Comparison of Outcomes of Endovascular Aneurysm Repair and a Brief Review of the Literature.

Background

Abdominal aortic aneurysms (AAAs) are life-threatening conditions that require timely intervention to prevent rupture. Endovascular aneurysm repair (EVAR) is preferred due to faster recovery and lower perioperative risk; however, intraoperative failure and long-term complications highlight the continued significance of open surgical repair (OSR) and the need for improved risk assessment.

Methods

This retrospective study analyzed data from 210 patients who underwent EVAR (n = 163) or OSR (n = 47) at a single center. Clinical characteristics, complications, reintervention rates, and 30-day mortality were recorded. EVAR-to-OSR conversion and mortality predictors in AAA treatments were identified.

Results

The overall mortality rate was 9.5% (20/210 patients), with 12 patients (7.3%) in the EVAR group and 8 patients (17%) in the OSR group (p = 0.085). Five patients required early and six required late conversion to open surgery. In follow-ups beyond 30 days, the reintervention rate for EVAR was higher (HR: 1.2, 95% CI: 0.4-3.6; p = 0.754). According to the multivariable analysis, rupture (p = 0.045), female sex (p = 0.018), body weight (p = 0.003), and aortic size index (p = 0.019) were significant predictors of mortality, whereas OSR was not (p = 0.212).

Conclusions

Treatment optimization requires a balanced approach, integrating both EVAR and OSR based on patient-specific factors. Maintaining expertise in both techniques is essential to ensure the best possible outcomes, and OSR should remain a viable option when clinically indicated.