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

Our own long-term results and the numerous published data from the literature indicate that after open surgery or endovascular treatment, there is no significant difference with regard to morbidity and lethality in the early and long-term postoperative outcome of patients with low comorbidity ("low-risk" patients or patients "fit for open repair"). The advantage of endovascular aneurysmatic "repair" (EVAR) is revealed only in risk patients resulting in the fact that patient selection has a decisive role for the prognosis. Typical EVAR-associated complications such as late ruptures and secondary conversions, the re-intervention rate post-EVAR between 20 and 30 % as well as the appropriate training of young vascular surgeons favour a not too stringent limitation, i.e., preservation of open abdominal aneurysm surgery in suitable patients and indications.