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 PS20. A Comparative Study of Open vs. Endovascular Repair of Inflammatory Abdominal Aortic Aneurysms

​​Stavros K. Kakkos1, Konstantinos O. Papazoglou2, Ioannis A. Tsolakis1, George Lampropoulos1, Spyros I. Papadoulas1, Pavlos N. Antoniadis3
1University Hospital of Patras, Patras, Greece; 2University of Thessaloniki, Thessaloniki, Greece; 3Konstantopoulio Hospital, Athens, Greece.

OBJECTIVES: Open repair (OR) of inflammatory abdominal aortic aneurysms (IAAA) is challenging due to adhesions of the aneurysm with the surrounding structures and can be associated with significant morbidity. In recent years, endovascular aneurysm repair (EVAR) has emerged as a promising, less invasive approach, although there is a paucity of studies comparing directly these two methods of repair. The aim of our retrospective comparative investigation was to study IAAA outcome after OR compared to EVAR.
 
METHODS: Twenty seven patients (26 males, median age 67 years) with a non-ruptured IAAA were included. Mean (sd) IAAA size was 6.0 (1.3) cm. Preoperative pain was reported in 15 cases (56%). Nine patients were managed with EVAR under local (n=8) or spinal anaesthesia (n=1) and 18 with OR under general anaesthesia.
 
RESULTS: Preoperative characteristics of the two study groups were comparable. In the EVAR group, transfusion needs were reduced by 67%, procedure duration was shortened by 58% and postoperative hospitalization was shortened by 4 days (50%), all statistically significant compared to OR (Table 1). A trend for reduced morbidity and in-hospital mortality after EVAR was also observed. No AAA-related death occurred during follow-up.
 
CONCLUSIONS: Endovascular repair of IAAAs, accomplished in a less invasive manner, is associated with a smoother postoperative course and shorter hospital stay compared to OR. Further studies should focus on the role of EVAR and provide long-term results, including total and aneurysm-related mortality.
 
AUTHOR DISCLOSURES: P. N. Antoniadis: Nothing to disclose; S. K. Kakkos: Nothing to disclose; G. Lampropoulos: Nothing to disclose; S. I. Papadoulas: Nothing to disclose; K. O. Papazoglou: Nothing to disclose; I. A. Tsolakis: Nothing to disclose.
 

Results of endovascular and open repair of inflammatory abdominal aortic aneurysms

Endovascular repair (n=9)
Open repair (n=16)
p value
Number of transfused RBC units [median (interquartile range)]
1.0 (0-1)
3.0 (2.0-5.0)
0.001
Procedure duration [median (interquartile range)] (min)
70 (68-105)
240 (180-360)
0.001
Postoperative hospitalization [median (interquartile range)] (days)
4.0 (2.5-7)
8.0 (6.5-11.5)
0.004
Morbidity
11%
33%
0.36*
In-hospital mortality
0%
11%
0.54
Overall five-year survival
100%
75%
0.75

 

*odds ratio 4.0

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