AAA Repair

Abdominal Aortic Aneurysm Repair

Randomized trials have shown that for patients with a large abdominal aortic aneurysm endovascular repair offers a perioperative survival benefit over open repair. However, this advantage is not sustained beyond 2 years after surgery. There is concern that endovascular repair lacks durability, which may lead to an increased risk of late rupture, and that more reinterventions are required in patients undergoing this technique.

How does survival differ among patients who were treated with endovascular and open repair of abdominal aortic aneurysm?
Six years after randomization, the cumulative overall survival rates were 69.9% for open repair and 68.9% for endovascular repair, for a difference of 1.0 percentage point (95% confidence interval, −8.8 to 10.8; P=0.97). The increased perioperative mortality after open repair was counterbalanced by a larger number of deaths after discharge following endovascular repair.

What were the most common complications after repair of abdominal aortic aneurysms?
A: For open repair, the most frequent secondary intervention was correction of an abdominal incisional hernia, whereas endovascular-repair interventions were most often performed because of endograft-related complications such as endoleak and endograft migration.

What were the most common causes of death among patients who had undergone an abdominal aortic aneurysm repair?
A: The most common causes of death were cardiovascular causes (myocardial infarction, cardiac arrest, congestive heart failure, stroke and ruptured aneurysm), cancer, and pulmonary causes.

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http://content.nejm.org/cgi/content/abstract/362/20/1881