# Endovascular and Open Surgical Repair of Intact Abdominal Aortic Aneurysms: Outcomes, Treatment Trends and Early Mortality Risk Factors in a Single-Centre Study over 18 Years

## TL;DR

This study compares outcomes of endovascular and open surgical repair for abdominal aortic aneurysms over 18 years, finding lower in-hospital mortality with endovascular repair but lower long-term survival.

## Contribution

The study provides real-world evidence on treatment trends and mortality risk factors for abdominal aortic aneurysm repair over an 18-year period.

## Key findings

- EVAR had lower in-hospital mortality (0.93%) compared to OSR (3.48%).
- EVAR was associated with a 84% lower hospital mortality risk after risk adjustment.
- OSR-treated patients had prolonged survival during follow-up compared to EVAR.

## Abstract

Background: Endovascular aortic repair (EVAR) has become the standard approach for intact abdominal aortic aneurysm (iAAA) repair in recent decades. This retrospective single-centre study analyzed real-world treatment trends, early outcomes, and risk factors for in-hospital mortality following EVAR and open surgical repair (OSR) in patients treated for iAAA from 2005 to 2022. Methods: In-hospital mortality was the primary outcome. Univariate and multivariable logistic regression analyses were performed. Logistic and logarithmic regression models were established to assess temporal changes. Results: In total, 1237 patients (90% male, mean age 72 years) were included, comprising 863 EVAR and 374 OSR procedures. In-hospital mortality was lower after EVAR than OSR (0.93% vs. 3.48%; p = 0.001). After risk adjustment, higher age (adjusted odds ratio [OR] 2.39, 95% confidence interval [CI] 1.26–4.78; p = 0.007) and chronic obstructive pulmonary disease (OR 4.43, 95% CI 1.82–10.8; p = 0.001) were associated with higher in-hospital mortality. Conversely, EVAR (vs. OSR; OR 0.16, 95% CI 0.06–0.43; p < 0.001) was associated with a lower hospital mortality risk. Throughout the study, in-hospital mortality rates for EVAR and OSR remained stable. With a median follow-up of 21 months, OSR-treated patients presented prolonged survival during follow-up (p = 0.021). Conclusions: EVAR represents a reliable alternative for elderly patients with multiple comorbidities considered unfit for OSR. Although EVAR was associated with lower in-hospital mortality, survival was lower during the 5-year follow-up compared to OSR.