H. Krishnamoorthi1,3, H. Jeon-Slaughter2,4, A. Wall1, S. Banerjee2,4, B. Ramanan1,3, C. Timaran1,3, J. G. Modrall1,3, S. Tsai1,3 1VA North Texas Health Care System,Vascular Surgery,Dallas, TX, USA 2VA North Texas Health Care System,Cardiology,Dallas, TX, USA 3University Of Texas Southwestern Medical Center,Vascular Surgery,Dallas, TX, USA 4University Of Texas Southwestern Medical Center,Cardiology,Dallas, TX, USA
Introduction: While long-term durability and improved peri-operative outcome of endovascular AAA repair has been demonstrated, some studies have suggested an increased rate of secondary interventions compared with open AAA repair. More recent data suggest that rates between the two modalities may be similar. We investigated the rate of secondary intervention in patients undergoing elective EVAR or open AAA repair and the effect of AAA size in these two groups of patients.
Methods: A retrospective, single-institution review was conducted between January 2003 and December 2012. Secondary intervention was defined as any intervention within 30 days of the procedure or an AAA repair-related procedure after 30 days, which included repair of endoleaks and incisional hernia repair. Cochran-Mantel-Haenszel statistics were conducted to examine associations between AAA size and need for secondary interventions over 10 years.
Results: A total of 342 patients underwent elective AAA repair. 274 patients underwent elective EVAR and 68 patients underwent open AAA repair. The mean age of patients treated with EVAR was 69±9 years, while the mean age of patients treated with open AAA repair was 67±7 years. The mean follow-up period was 49 months post-EVAR (standard deviation 29 months) and 78 months post-open repair (standard deviation 46 months). The rate of secondary intervention was significantly lower in the EVAR group compared with the open AAA repair group (14.9% vs 27.9%, p=0.004). The most common secondary intervention was repair of type II endoleak (n=14, 5.1%) after EVAR and incisional hernia repair (n=4, 5.9%) after open AAA repair. Of the 274 EVAR patients, 133 (48.5%) died during the study period, while 34 (50%) of the 68 open AAA repair patients died during the study period. Need for secondary intervention was not associated with long-term mortality in either the EVAR or the open repair group (p=0.11 and p=0.87, respectively). Furthermore, in both the open repair and EVAR groups, AAA size was not associated with rate of secondary intervention.
Conclusion: The rate of secondary intervention in patients treated with EVAR is significantly lower than in patients treated with open AAA repair. However, secondary intervention is not associated with long-term survival in either group.