Open versus Endo: Early Experience with Endovascular Abdominal Aortic Aneurysm Repair beyond the Clinical Trials


  • Trent L. Prault
  • Scott L. Stevens
  • Michael B. Freeman
  • David Cassada
  • Rob Hardin
  • Mitchell H. Goldman



Objective: To analyze and compare open (OR) versus endovascular (EVAR) abdominal aortic aneurysm repair at our institution.

Methods: EVAR was attempted in 256 patients at the University of Tennessee Medical Center, Knoxville, between December 1999 and November 2002. One hundred forty patients underwent attempted EVAR, and 116 underwent OR. All patients were included on an intent-to-treat basis, and results were reviewed retrospectively. Statistical methods included the Student t test and chi-square analysis.

Results: Patients were age matched between the 2 groups (70.2 years versus 69.0 years; P = .936). Patients in the OR group had significantly higher American Society of Anesthesiologists classes than the EVAR group (2.96 versus 3.07; P = .006). However, there was no difference between the groups, OR versus EVAR, with respect to the presence of chronic obstructive pulmonary disease (55% versus 46%; P = .129), coronary artery disease (69% versus 66%; P = .638), diabetes mellitus (12% versus 18%; P = .167), mean left ventricular ejection fraction (51.8% versus 53.9%; P = .28), or mean preoperative creatinine level (1.2 mg/dL versus 1.1 mg/dL; P = .167). Tobacco use was more prevalent in the OR group (78.4% versus 64.2%; P = .013), and known carotid artery disease was more prevalent in the EVAR group (20.0% versus 6.9%; P = .003). The EVAR group had significantly shorter lengths of stay ( 4.2 versus 9.0 days; P = .000), intensive care unit days (0 versus 3.2; P = .000), time in the operating room (119.6 minutes versus 225.7 minutes; P = .000), and estimated blood loss (189.1 mL versus 897.9 mL; P = .000). Mean aneurysm size was larger in the OR group (5.6 cm versus 4.9 cm; P = .000). Perioperative complications occurred in 31 patients in the OR group and 5 in the EVAR group (P = .000). Two perioperative deaths occurred in the OR group and none in the EVAR group. As of this writing there has been no significant difference in all-cause mortality in the 2 groups (OR 9.6% versus EVAR 8.0%; P = .651). Seven patients in the EVAR group needed secondary interventions. Six were managed with endovascular techniques, and 1 underwent femoral-femoral bypass.

Conclusions: Patients who undergo EVAR have significantly less morbidity and mortality in the perioperative period than do equally matched patients undergoing open repair. In midterm follow-up (2-5 years), mortality is no different. Morbidity conferred by the need for secondary intervention in the endovascular group is minimal.


Ahn SS, Rutherford RB, Johnston KW, et al. 1997. Reporting standards for infrarenal endovascular abdominal aortic aneurysm repair. J Vasc Surg 25:405-10.nConners MS, Sternbergh WC, Carter G, Tonnessen BH, Yoselevitz M, Money SR. 2002. Secondary procedures after endovascular aortic aneurysm repair. J Vasc Surg 36:992-6.nFaries PL, Brener BJ, Connelly TL, et al. 2002. A multicenter experience with the Talent endovascular graft for the treatment of abdominal aortic aneurysms. J Vasc Surg 35:1123-8.nHarris PL, Vallabhaneni SR, Desgranges P, Becquemin JP, Marrewijk CV, Laheij RJF. 2000. Incidence and risk factors of late rupture, conversion, and death after endovascular repair of infrarenal aortic aneurysms: the Eurostar experience. J Vasc Surg 32:739-49.nMakaroun MS. 2001. The Ancure endografting system: an update. J Vasc Surg 33:S129-34.nMay J, White GH, Waugh R, et al. 2001. Improved survival after endoluminal repair with second generation prostheses compared with open repair in the treatment of abdominal aortic aneurysms: a 5-year concurrent comparison using life table method. J Vasc Surg 33(2 suppl):S21-6.nMoore WS, Dashyap VS, Vescera CL, Quinines-Baldrich WJ. 1999. Abdominal aortic aneurysm: a 6-year comparison of endovascular versus transabdominal repair. Ann Surg 230: 298-306.nMoore WS, Matsamura JS, Makaroun MS, et al. 2003. Five-year interim comparison of the Guidant bifurcated endograft with open repair of abdominal aortic aneurysm. J Vasc Surg 38:46-55.nOhki T, Veith FJ, Shaw P, et al. 2001. Increasing incidence of midterm and long-term complications after endovascular graft repair of abdominal aortic aneurysms: a note of caution based on a 9-year experience. Ann Surg 234:323-35.nParodi JC, Palmaz JC, Barone HD. 1991. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg 6:491-9.nUflacker R, Robison J. 2001. Endovascular treatment of abdominal aortic aneurysms: a review. Eur Radiol 11:739-53.nZarins CK, White RA, Moll FL, et al. 2001. The AneurRx stent graft: four-year results and worldwide experience 2000. J Vasc Surg 33:S135-45.n



How to Cite

Prault, T. L., Stevens, S. L., Freeman, M. B., Cassada, D., Hardin, R., & Goldman, M. H. (2005). Open versus Endo: Early Experience with Endovascular Abdominal Aortic Aneurysm Repair beyond the Clinical Trials. The Heart Surgery Forum, 7(5), E459-E461.




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