["EVAR First" also in "Fit-for-Open-Repair" Patients? - 'CON' Statement]

Area of Science:

• Vascular Surgery
• Medical Technology Assessment

Background:

• Comparative outcomes of open surgery versus endovascular aneurysm repair (EVAR) are crucial for patient management.
• Low comorbidity patients ('low-risk' or 'fit for open repair') represent a significant population in aneurysm treatment.
• Understanding long-term results and potential complications is vital for evidence-based practice.

Purpose of the Study:

• To compare the early and long-term postoperative outcomes of open surgery and EVAR in patients with varying comorbidity levels.
• To determine the role of patient selection in the prognosis of EVAR.
• To evaluate the implications of EVAR-associated complications and re-intervention rates on treatment strategies.

Main Methods:

• Analysis of long-term results from the authors' own data.
• Comprehensive review of published literature on open surgery and EVAR for abdominal aortic aneurysms.
• Stratification of patients based on comorbidity status ('low-risk' vs. 'risk' patients).

Main Results:

• No significant difference in morbidity and lethality between open surgery and EVAR for low-risk patients in early and long-term follow-up.
• EVAR demonstrates an advantage primarily in high-risk patients, highlighting the critical role of patient selection.
• EVAR is associated with a 20-30% re-intervention rate and potential complications like late ruptures and secondary conversions.

Conclusions:

• Patient selection is paramount for successful EVAR outcomes.
• Open abdominal aortic aneurysm surgery should be preserved for suitable patients and indications, considering EVAR's limitations.
• The findings support a balanced approach to aneurysm repair, utilizing both open and endovascular techniques judiciously.