EVAR Compared to Open Repair in Younger Patients

March 12, 2015—Noting that the role of endovascular repair (EVAR) of aortic aneurysms in young patients is controversial, Kevin Lee, MD, et al conducted a study to determine the long-term outcomes and reintervention rates in patients 60 years of age or younger who underwent elective open repair or EVAR of an abdominal aortic aneurysm (AAA). The investigators published the study in the Journal of Vascular Surgery (2015;61:636–641).

The study found that after elective aneurysm repair, younger patients have a moderate life expectancy related to malignant disease and cardiovascular health. EVAR offers durability and long-term survival similar to open repair in these younger patients as long as aneurysm anatomy and instructions for use (IFU) are adhered to, the investigators concluded.

The investigators conducted a retrospective review of a prospectively collected vascular surgery database at a university-affiliated medical center to identify all patients who underwent elective AAA repair between 2000 and 2013 and were ≤ 60 years of age at the time of the repair. Preoperative anatomic measurements were performed and compared with IFU criteria for the endografts. The study cohort comprised 169 patients ≤ 60 years of age who underwent elective repair (119 open repair, 50 EVAR).

In Journal of Vascular Surgery, the investigators reported that the overall in-hospital mortality rate was 1.8% (0% EVAR, 2.5% open repair). Overall mean life expectancy was 11.5 years (9.8 years EVAR, 11.9 years open repair). The 1-year, 5-year, and 10-year survival rates did not differ between EVAR and open repair. Additionally, long-term survival and reintervention rates did not differ. No late aneurysm rupture or aneurysm-related deaths were observed.