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IFT: International Fast Talk

IFT02 - Open Repair of an Infrarenal Aortic Aneurysm is Superior to Endovascular Repair Even in Case of Sac Shrinkage at Fifteen-year Follow-up

Wednesday, June 15, 2022
6:35 AM – 6:40 AM EDT
Objectives: To report very long-term results of infrarenal abdominal aortic aneurysm (AAA) in a single tertiary Hospital.

Methods: 1777 consecutive AAA repairs (2003-2018) were included. Primary outcomes were all-cause mortality, AAA-related mortality, reinterventions rate. Open repair (OSR) was offered in case the patient had a functional capacity >=4 metabolic equivalents (MET), and a predicted>10 year life expectancy.Endovascular repair (EVAR) was offered in case of hostile abdomen, presence of anatomic feasibility for standard endovascular graft, and < 4 MET. Sac shrinkage was defined as a reduction of both anterior-posterior and latero-lateral diameter of the sac of at least 5 mm at the last follow-up vs. the first post- operative follow-up imaging.

Results: 828 (47%) OSRs and 949 (53%) EVARs were performed. 93.5% (n=1661) were male, mean age was 73.8 years. Mean follow-up was 79 (SD: 51) months. Summary follow-up index was 0.91. 30-day mortality was .7% (n=6) and .6% (n=6) for OSR and EVAR respectively. Survival rate was 97.6% and 94% at 1 year, 83.6% and 75% at 5 years, 59.6% and 45.8% at 10 years, and 33.1% and 20.7% at 15 years for OSR and EVAR, respectively (P <.001). Any statistical difference was found for the survival outcome in case of sac shrinkage (P=.1). At the last follow-up 15 (1.8%) vs. 23 (2.4%) AAA-related deaths occurred in the OSR vs EVAR group, respectively (P=.37). Freedom from reintervention was 97% and 96% at 1 year, 96.5% and 88.4% at 5 years, 95.8% vs. 81.7% at 10 years, and 94.6% vs.72.3% at 15 years for OSR and EVAR, respectively (P <.001). In the EVAR group the reintervention rate was significantly lower for the sac shrinkage subgroup (P <.001) but still higher than the OSR group (see Figures 1 a and 1b). 664 (70%) sac shrinkage occurred at the last follow-up.

Conclusions: Following current guidelines, OSR of an infrarenal AAA is superior to EVAR even in case of sac shrinkage at a very long-term follow-up. We strongly think that OSR proportion of AAA repair should not be less than 40-45% in a vascular center.