Outcomes of Open Repair of Complex AAA and Classification System Provide Standards of Comparison for Fenestrated EVAR

June 17, 2011—The Society for Vascular Surgery (SVS) announced that findings from an analysis of outcomes of open repair of complex abdominal aortic aneurysms (cAAAs) were presented at the SVS 2011 Vascular Annual Meeting in Chicago. SVS noted that the analysis was based on an anatomic and endovascular classification system, thereby providing a standard of comparison for fenestrated endovascular repair (EVAR).

“We reviewed outcomes of 461 patients who underwent open cAAA repair from 2000 to 2010,” stated Gustavo S. Oderich, MD. “Preoperative digital imaging was analyzed by a blinded investigator using centerline of flow to define aneurysm extent and the expected number of fenestrations that would be required to provide 2 cm of proximal seal for fenestrated EVAR. Endpoints were mortality, morbidity, renal function deterioration, reinterventions, and patient survival.”

According to Dr. Oderich, there were 354 men and 107 women with a mean age of 73 ± 8 years. The operative mortality rate was 1.3% (6 of 461 patients). The rate of any morbidity was 57% (260 patients) and was severe (SVS score of 3) in 20% (91 patients). The 5-year rates of patient survival, freedom from reintervention, and freedom from renal function deterioration were 72% ± 3%, 90% ± 2%, and 84% ± 3%, respectively. Increasing level of aneurysm complexity was associated with greater mortality, severe morbidity, and dialysis rates.

The investigators concluded that open cAAA repair can be performed safely with a low mortality rate (1.3%) but with a high risk of complications. These data, stratified by anatomic classification and the expected number of fenestrations, provide a benchmark for comparison with results of fenestrated EVAR.