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Endovascular repair of abdominal aortic aneurysm (AAA) was developed for patients who are poor surgical candidates for open repair, but has since become the more common approach for all patients. Endovascular repair has lower short-term mortality and complication rates, but in the long term, this approach may have a higher complication rate and no survival advantage over open repair. In this retrospective cohort study, researchers further explored the comparison by identifying 4529 Medicare beneficiaries (mean age, 76) who underwent isolated open or endovascular repair (703 and 3826, respectively) of intact AAA from 2003 through 2007.
Open repair was more common than endovascular repair in women (29% vs. 20%). During a median follow-up of 2.5 years, the adjusted hazard for all-cause mortality was 24% higher in the open-repair cohort than in the endovascular-repair cohort. In absolute terms, 13 fewer deaths per 1000 person-years occurred with endovascular repair than with open repair. All the excess mortality (whether all-cause or AAA-specific) occurred within the first month postsurgery.
Jackson RS et al. Comparison of long-term survival after open vs endovascular repair of intact abdominal aortic aneurysm among Medicare beneficiaries. JAMA 2012 Apr 18; 307:1621. (http://dx.doi.org/10.1001/jama.2012.453)
Comment
In the long term, endovascular repair of abdominal aortic aneurysm appears to perform as well as or better than open repair among patients with similar baseline characteristics, although a retrospective cohort study can never adjust for all factors. These results in older patients suggest that selection of a procedure should be based more on anatomic features (i.e., whether the patient satisfies anatomic criteria for endovascular graft placement) than on demographic or clinical features.