[Surgery for abdominal aortic aneurysm: open or endovascular repair?]

Endovascular repair (EVAR) of asymptomatic abdominal aortic aneurysm is an attractive alternative to open surgery due to its lower perioperative mortality and faster recovery. However, the similar survival rates for open repair and EVAR after 2-4 years have raised questions on the durability of EVAR. Recently published long term results from the Dutch DREAM trial and the EVAR-1 trial in the UK showed that survival rates after open surgery and EVAR remain comparable after 6-8 years of follow-up. However, re-intervention rates after EVAR were 30%, compared to 10-15% after open surgery. The advantages of EVAR have to be offset against a higher rate of re-intervention when deciding on individual treatment. Open surgery may be the better option for a younger patient, EVAR for an older patient. Long term follow-up of the EVAR-2 trial confirms that in patients with severe comorbidity EVAR has no benefit over conservative treatment.