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The Journal of Cardiovascular Surgery 2014 April;55(2):257-63


lingua: Inglese

Early and long-term outcomes after open or endovascular repair for abdominal aortic aneurysms in high-risk patients

Pane B. 1, Spinella G. 1, Signori A. 2, Musio D. 1, Perfumo M. C. 1, Lucertini G. 1, Rousas N. 1, Palombo D. 1

1 Vascular and Endovascular Surgery Unit University Hospital IRCCS San Martino‑IST University of Genoa, Genoa, Italy; 2 Biostatistics Unit Health Sciences Department (DISSAL) University of Genoa, Genoa, Italy


AIM: The aim of our study was to evaluate the earlier and long term survival as well the postoperative complications in high-risk patients who received endovascular aortic repair (EVAR) as first choice, or open repair when anatomical requirements for EVAR were not met.
METHODS: Between January 2005 and January 2010, 593 patients underwent procedures for elective abdominal aortic aneurysm (AAA) repair; 172 of these were considered at high risk according to the American Society of Anesthesiology (ASA) score (ASA III and IV): 150 high-risk patients were males (mean age 72.7, range 53-93 years) and 22 females (mean age 72.9 years, range 60-90 years). The median AAA diameter was 64 (53-75) mm in the open repair group and 62 (55-70) mm in the EVAR group. 121 patients underwent open repair and 51 EVAR, respectively.
RESULTS: The 30-day mortality rate was 0% in the EVAR group and 2.4% (3/121) in the open repair group (P=0.26). Long-term results showed: no EVAR-related mortality, no late conversion to open repair in the EVAR group was required during follow-up. No aneurysmal expansion was observed. In the open repair group, no graft-related events were observed during follow-up. The mean follow-up for survival analysis was 1542 days. Overall 5-year survival was 71.7% (SE=4.2%). Survival during follow-up was 92.2%, 86.1%, 76.2%, 65.9% and 61.8% at 12, 24,36,48,60 months respectively in EVAR Group. Open Group present long term survival of 95%, 88.9%, 83.9%, 79.7%, 76% at 12, 24, 36, 48, 60 months respectively.
CONCLUSION: Our results in open repair surgery show a perioperative low mortality rate with high survival rate in long term. This result could be successfully achieved even in high-risk patients unsuitable for EVAR.

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