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Home > Vascular Annual Meeting > pvss8_wahlgren_outcomes

PVSS8. Outcomes of Endovascular Abdominal Aortic Aneurysm Repair Compared to Open Surgical Repair In High-Risk Patients: Results from the Swedish Vascular Registry

Carl Wahlgren, Jonas Malmstedt, on behalf of the Swedish Vascular Registry.
Karolinska University Hospital, Stockholm, Sweden.

OBJECTIVES: The management of infrarenal aortic aneurysms in high-risk patients remains a challenge. Endovascular repair is associated with superior short term mortality rates but unclear long-term results in high-risk populations and has not been shown to improve survival in patients unfit for open repair. The aim of this study was to evaluate the outcome following elective endovascular aneurysm repair (EVAR) compared to open repair (OR) in a high-risk patient cohort

METHODS: Prospectively collected data from January 2000 to December 2006 were retrieved from the Swedish Vascular Registry. The high-risk cohort was defined as age ≥60 years, ASA 3 or 4, and at least one cardiac, pulmonary or renal comorbidity. There were 217 of 1000 EVAR patients and 483 of 2831 OR patients that met these criteria. Primary end-points were 30-day and 1-year all-cause mortality. Kaplan-Meier curves for survival and multivariate Cox regression analyses were performed

RESULTS: The crude 30-day and 1-year all-cause mortality for the whole treatment group (n=3831) were 1.8% (EVAR) vs. 2.8% (OR) and 8.0% (EVAR) vs. 7.2% (OR), respectively. In the high-risk cohort (n=700) mean age was 75±7 years (EVAR) vs. 73±6 years (OR) [p=0.001], women 15% (EVAR) vs. 17% (OR) [NS], smoking 30% (EVAR) vs. 47% (OR) [p=0.001], cardiac 87% (EVAR) vs. 86% (OR) [NS], pulmonary 33% (OR) vs. 32% (EVAR) [NS], and renal disease 26% (EVAR) vs. 18% (OR) [p=0.02], and ASA 3 92% (EVAR) vs. 95% (OR) [NS]. The mean follow-up time was 2.6 [95%CI 2.5-2.8] years. There was no difference in all-cause mortality at 30-days [EVAR 4.6% vs. OR 3.3%], but OR had lower 1-year mortality [9.3% vs. 17.9%; p=0.003]. EVAR was associated with increased mortality risk after adjusting for age, ASA, and comorbidities [hazard ratio 1.50, 95% CI 1.07-2.12; p=0.02]. Kaplan-Meier survival analysis showed a lower mortality for patients undergoing OR which remained greater than EVAR during follow-up [p=0.001]

CONCLUSIONS: Open elective aortic aneurysm repair seems to have a better outcome compared to EVAR in this specific high-risk patient cohort after adjusting for covariates. We can not confirm the benefit for EVAR from previous registry studies with a similar high-risk definition. In clinical practice, open repair may be at least as good as EVAR in high-risk patients fit for surgery