A 15-Year Single-Center Experience Treating Complex Aortic Aneurysms: Transitioning From Open to Complex Endovascular...

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Aneurysm Treatment

Background:

• Complex aortic aneurysms present significant treatment challenges.
• The introduction of complex endovascular aortic repair (EVAR) alongside open surgical repair (OSR) has altered treatment paradigms.
• Tertiary referral centers manage a diverse range of complex aneurysm cases.

Purpose of the Study:

• To analyze real-world clinical profiles and surgical outcomes of complex (thoraco-)abdominal aneurysm patients.
• To evaluate the current decision-making process for surgical versus endovascular repair.
• To assess outcomes based on patient frailty and treatment modality.

Main Methods:

• Retrospective analysis of patients undergoing OSR and complex EVAR (2008-2023).
• Analysis of treatment decision rationale and patient characteristics.
• Subanalysis of frailest complex EVAR patients deemed unfit for OSR.

Main Results:

• 112 OSR and 119 complex EVAR patients were included; patient preference often guided shared decision-making.
• Complex EVAR patients had higher comorbidity scores (Charlson Comorbidity Index).
• OSR had more complications (31.3%), while complex EVAR had more reinterventions (20.2%).
• Frailest complex EVAR patients (n=47) showed lower survival and high 1-year mortality (23.8%).

Conclusions:

• Complex EVAR, while less complicated than OSR, involves significant risks, particularly for frail patients.
• Current selection processes identify frail patients for complex EVAR but may not optimize non-surgical management candidates.
• Further insights into patient selection are crucial for improving outcomes in complex aneurysm treatment.