PMID- 15557895
OWN - NLM
STAT- MEDLINE
DCOM- 20041217
LR  - 20161124
IS  - 0741-5214 (Print)
IS  - 0741-5214 (Linking)
VI  - 40
IP  - 5
DP  - 2004 Nov
TI  - Clinical effect of abdominal aortic aneurysm endografting: 7-year concurrent 
      comparison with open repair.
PG  - 841-8
AB  - OBJECTIVE: We compared the effectiveness and clinical outcome of open repair 
      versus endovascular aortic aneurysm repair (EVAR) in achieving prevention of 
      abdominal aortic aneurysm (AAA)-related death and graft-related complications. 
      METHODS: Over 7 years from 1997 to 2003, 1119 consecutive patients underwent 
      elective treatment of infrarenal AAAs, 585 with open repair and 534 with EVAR. 
      Patients were regularly followed up at 1, 6, 12 months, and every 6 months 
      thereafter, in EVAR group, and at 3 and 12 months, and yearly thereafter after 
      open repair. Preoperative, intraoperative, and follow-up data were stored in a 
      prospective database. RESULTS: Median follow-up was similar in the 2 groups: 33 
      months (interquartile range [IQR], 13-50 months) in the EVAR group vs 35 months 
      (IQR, 15-54 months) in the open repair group. EVAR group patients were older than 
      patients in the open repair group: 73 years vs 72 years (P = .04). There were 
      statistical significant differences between the EVAR group and the open repair 
      group with respect to AAA median diameter (52 mm vs 56 mm), coronary disease rate 
      (46% vs 37%; P = .001), pulmonary disease rate (56% vs 38%; P < .0001), and 
      American Society of Anesthesiologists IV score rate (16% vs 6%; P < .0001). 
      Thirty-day mortality in the EVAR group was 0.9% (5 of 534 patients), compared 
      with 4.1% (24 of 585 patients; P = .001) in the open repair group, and major 
      morbidity was 9.1% (49 of 534 patients) vs 18.6% (109 of 585 patients; P < 
      .0001), respectively. The incidence of secondary procedures in the EVAR group was 
      15.7%, compared with 3% in the open repair group (P < .0001). There were no 
      deaths related to secondary procedures in either group. Six AAAs (1.1%) ruptured 
      after EVAR, 3 of which were fatal; in the open repair group 1 patient (0.2%) 
      underwent successful repeat operatation to treat iliac pseudoaneurysm rupture 5 
      years after the original procedure. Kaplan-Meier estimates for freedom from 
      aneurysm-related death at 84 months were 97.5% in the EVAR group and 95.9% in the 
      open repair group (log rank test, P = .008). Kaplan-Meier survival estimates at 
      84 months were 67.1% in the open repair group and 66.9% in the EVAR group (P = 
      NS). At the same interval the risk for secondary procedures was 49.4% for the 
      EVAR group and 7.1% for the open repair group. Of the 11 variables analyzed with 
      logistic analysis, open surgery (hazard ratio [HR], 11; 95% confidence interval 
      [CI], 2.5-54.2; P = .002), American Society of Anesthesiologists IV score (HR, 
      7.1; 95% CI, 2.7-18.8; P = .0001), and age (HR, 1.06; 95% CI, 1.04-1.13; P = .04) 
      were positive independent predictors of perioperative mortality. CONCLUSION: Our 
      data suggest that at a maximum follow-up of 7 years, patients who undergo EVAR 
      show lower perioperative and late aneurysm-related mortality compared with a 
      younger and substantially healthier group of patients with aneurysms treated with 
      open repair. The higher need for secondary procedures in the endovascular group 
      did not affect superiority of the overall performance of EVAR in the early and 
      late intervals.
FAU - Cao, Piergiorgio
AU  - Cao P
AD  - Unit of Vascular Surgery, Policlinico Monteluce, Azienda, Ospedaliera di Perugia, 
      Perugia 06122, Italy. pcao@unipg.it
FAU - Verzini, Fabio
AU  - Verzini F
FAU - Parlani, Gianbattista
AU  - Parlani G
FAU - Romano, Lydia
AU  - Romano L
FAU - De Rango, Paola
AU  - De Rango P
FAU - Pagliuca, Valentino
AU  - Pagliuca V
FAU - Iacono, Gustavo
AU  - Iacono G
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - J Vasc Surg
JT  - Journal of vascular surgery
JID - 8407742
SB  - IM
MH  - Aged
MH  - Angiography
MH  - Aortic Aneurysm, Abdominal/diagnostic imaging/*mortality/*surgery
MH  - *Blood Vessel Prosthesis
MH  - Blood Vessel Prosthesis Implantation/adverse effects/*methods
MH  - Cohort Studies
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Intraoperative Complications/epidemiology
MH  - Italy
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Minimally Invasive Surgical Procedures/methods
MH  - Multivariate Analysis
MH  - Postoperative Complications/epidemiology
MH  - Probability
MH  - Prosthesis Failure
MH  - Retrospective Studies
MH  - Severity of Illness Index
MH  - Survival Analysis
EDAT- 2004/11/24 09:00
MHDA- 2004/12/18 09:00
CRDT- 2004/11/24 09:00
PHST- 2004/11/24 09:00 [pubmed]
PHST- 2004/12/18 09:00 [medline]
PHST- 2004/11/24 09:00 [entrez]
AID - S0741521404011322 [pii]
AID - 10.1016/j.jvs.2004.08.040 [doi]
PST - ppublish
SO  - J Vasc Surg. 2004 Nov;40(5):841-8. doi: 10.1016/j.jvs.2004.08.040.