The place of endovascular treatment in abdominal aortic aneurysm

The endovascular treatment of abdominal aortic aneurysms has become more common. A careful comparison of this technique with the established treatment by open surgery is needed before it can be more widely adopted.

We selectively searched the Medline database for articles on the endovascular treatment of abdominal aortic aneurysms, with special attention to prospective, randomized trials comparing it to open aortic surgery (keywords: "endovascular abdominal aortic repair" and "prospective randomized trial").

Data on 30-day mortality and long-term survival are now available from four randomized multicenter trials. In three of these trials, endovascular treatment was found to lower 30-day mortality by two-thirds (endovascular: 0.2% to 1.7%, open repair: 0.7% to 4.7%), but this difference in survival was no longer present at two years. Compared to open open aortic surgery, endovascular treatment has a higher long-term complication rate. Endoleakage (perigraft leakage) accounted for more than 30% of complications and was the commonest reason for reintervention and unsuccessful intervention; in nearly all cases, it was successfully treated by the endovascular route. The rate of secondary aortic rupture was 0.8%, and migration of the prosthesis occurred in 5% of cases. Follow-up checks of the stent graft are now recommended at 3, 6 and 12 months after implantation, and annually thereafter.

Prospective randomized trials have shown that the endovascular technique lowers perioperative mortality. In the long term, however, it has a higher complication rate than open aortic surgery and leads to more frequent reintervention.