Endovascular Versus Open Abdominal Aortic Aneurysm: Best Decision

Area of Science:

• Vascular Surgery
• Medical Device Technology
• Patient Outcomes Research

Background:

• Endovascular aneurysm repair (EVAR) has become a common treatment for abdominal aortic aneurysms (AAA).
• While EVAR demonstrated reduced early mortality compared to open repair, long-term durability and reintervention rates remain concerns.
• Patient characteristics, anatomical suitability, and device advancements influence treatment decisions.

Purpose of the Study:

• To review current data on abdominal aortic aneurysm (AAA) treatment options.
• To establish evidence-based selection criteria for choosing between open repair and endovascular aneurysm repair (EVAR).
• To analyze factors influencing long-term EVAR outcomes and complications.

Main Methods:

• Systematic review of historical trials and recent data on EVAR and open AAA repair.
• Analysis of patient-related factors, including age, health status, and life expectancy.
• Evaluation of anatomical criteria predictive of EVAR success and complications like endoleak.

Main Results:

• EVAR shows lower early mortality but higher reintervention rates compared to open repair beyond 4 years.
• Unfavorable anatomy is linked to increased complications, endoleaks, and late mortality after EVAR.
• Strict surveillance post-EVAR is necessary but incurs costs and risks, including radiation exposure and potential renal function decline.

Conclusions:

• Patient selection for AAA repair must integrate patient preferences, health status, and detailed anatomical assessment.
• EVAR may be considered outside standard indications in select cases, but risks of reintervention and surveillance must be weighed against open repair.
• Further research is needed to refine criteria for optimal AAA treatment selection, balancing efficacy, safety, and long-term outcomes.