Long-term Efficacy of EVAR in Patients Aged Less Than 65 Years with an Infrarenal Abdominal Aortic Aneurysm and Favorable Anatomy

Enrico Gallitto; Gianluca Faggioli; Chiara Mascoli; Paolo Spath; Rodolfo Pini; Jean-Baptiste Ricco; Antonino Logiacco; Alessia Sonetto; Mauro Gargiulo

doi:10.1016/j.avsg.2020.03.038

Long-term Efficacy of EVAR in Patients Aged Less Than 65 Years with an Infrarenal Abdominal Aortic Aneurysm and Favorable Anatomy

Ann Vasc Surg. 2020 Aug:67:283-292. doi: 10.1016/j.avsg.2020.03.038. Epub 2020 Apr 10.

Authors

Enrico Gallitto¹, Gianluca Faggioli², Chiara Mascoli², Paolo Spath², Rodolfo Pini², Jean-Baptiste Ricco³, Antonino Logiacco², Alessia Sonetto², Mauro Gargiulo²

Affiliations

¹ Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy. Electronic address: enrico.gallitto@gmail.com.
² Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy.
³ Department of Clinical Research, University Hospital of Poitiers, Poitiers, France.

PMID: 32283305
DOI: 10.1016/j.avsg.2020.03.038

Abstract

Background: The aim of this study was to compare early and long-term outcomes of endovascular aneurysm repair (EVAR) versus open surgical repair (OSR) in patients aged ≤ 65 years.

Methods: Data of patients aged ≤65 years undergoing infrarenal abdominal aortic aneurysm repair, between 2005 and 2013, were retrospectively reviewed. All EVAR procedures were performed according to the instruction for use, and only OSR procedures with an infrarenal aortic cross-clamping were included in the study.

Results: In this group of 115 patients (EVAR: 58 patients, 51% and OSR: 57 patients, 49%), EVAR and OSR patients had similar comorbidities, except for obesity (EVAR: 38% vs. OSR: 19%; P = 0.03). A stay in the intensive care unit (ICU) was necessary in 19% of patients with EVAR versus 79% with OSR (P = 0.001), and the amount of blood transfusion was 236 ± 31 mL for EVAR versus 744 ± 98 mL for OSR (P = 0.001). The hospital stay was 4 ± 2 days for EVAR versus 9 ± 6 days for OSR (P = 0.03). The overall 30-day mortality was 1% (EVAR: 0% vs. OSR: 2%; P = 0.30). Five patients (4%) required reinterventions within 30 days (EVAR: 0% vs. OSR: 8%, P = 0.001). The mean follow-up was 86 ± 38 months. Freedom from reintervention at 10 years after EVAR was 81% versus OSR 74%; (P = 0.77). Late reinterventions were reported in 13 patients (23%) with OSR and in 10 patients (17%) with EVAR. Postoperative retrograde ejaculation occurred more often in patients with OSR (31%) versus EVAR (2%) (P = 0.001). During the follow-up, cancer was found in 19 (17%) patients with no difference between EVAR and OSR (P = 0.83). The global survival at 10 years was 72% (EVAR: 79% vs. OSR: 70%; P = 0.94).

Conclusions: In this study, EVAR was associated with a shorter hospital stay, less need for the ICU, and less early reinterventions than OSR. Survival and reinterventions during the follow-up were not significantly different between EVAR and OSR. According to these results, EVAR may be considered for patients aged ≤65 years with a favorable anatomy.

Publication types

Comparative Study
Observational Study

MeSH terms

Age Factors
Aged
Aortic Aneurysm, Abdominal / diagnostic imaging
Aortic Aneurysm, Abdominal / mortality
Aortic Aneurysm, Abdominal / surgery*
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation* / adverse effects
Blood Vessel Prosthesis Implantation* / instrumentation
Blood Vessel Prosthesis Implantation* / mortality
Clinical Decision-Making
Databases, Factual
Endovascular Procedures* / adverse effects
Endovascular Procedures* / instrumentation
Endovascular Procedures* / mortality
Female
Humans
Length of Stay
Male
Middle Aged
Postoperative Complications / mortality
Postoperative Complications / therapy
Prosthesis Design
Retrospective Studies
Risk Factors
Stents
Time Factors
Treatment Outcome