Endovascular Aneurysm Repair Versus Open Surgical Repair in Treating Abdominal Aortic Aneurysm

Abstract

Abdominal aortic aneurysm (AAA) denotes an abdominal aorta dilation exceeding 3 cm, typically asymptomatic until rupture, posing severe consequences, including fatality. Therefore, continual screening is imperative, and surgical intervention is recommended upon reaching a diameter of 5.5 cm to prevent rupture. The primary surgical approaches are open surgical repair or open repair (OR) and endovascular aneurysm repair (EVAR). This review juxtaposes EVAR's short- and long-term effectiveness, safety, and perioperative complications in AAA patients versus OR, elucidating clinical benefits and avenues for further research. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, an extensive literature review was conducted using the PubMed and Clinicaltrials.gov databases. The review specifically focused on clinical studies directly comparing EVAR versus OR. The comprehensive literature review revealed that EVAR confers a survival advantage for up to four years post-procedure. However, the benefit shifts to OR after four to eight years due to aneurysm-related complications, such as ruptures, underscoring the necessity of lifelong post-EVAR monitoring. Following EVAR, AAA patients necessitate significantly more frequent secondary interventions due to graft-related issues, including endoleaks, thereby escalating long-term complexity and care costs. Conversely, following OR, a notably higher proportion of patients require mechanical ventilation and blood transfusions and experience prolonged intensive-care and mid-care unit stays, consequently extending hospitalization. After EVAR, patients recover substantially faster, returning to normal activities sooner. Nonetheless, the long-term quality of life between the two procedures becomes comparable. While EVAR presents itself as a less invasive alternative to OR, especially for high surgical risk patients, the imperative of long-term surveillance and the risk of secondary interventions pose significant challenges. Advancements in EVAR technology and technique are broadening its utility. Yet, continual research is crucial to optimize patient selection, improve long-term outcomes, and ensure that EVAR's benefits outweigh the risks. Therefore, choosing EVAR over OR in treating AAA patients must factor in a patient's overall health, anatomical considerations, and the probability of long-term success.

Keywords: abdominal aortic aneurysms (aaa); endovascular aortic repair (evar); open surgical repair (or); perioperative complications; postoperative mortality.

Figure 1. PRISMA flowchart for literature search.

We adhered to the PRISMA guidelines and conducted an extensive literature review using PubMed and Clinicaltrials.gov databases. Our primary emphasis was on studies examining the short- and long-term safety, efficacy, perioperative complications, and quality of life of patients with abdominal aortic aneurysms after undergoing endovascular aneurysm repair and open surgical repair. n, number; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses