Open Surgical Repair of Abdominal Aortic Aneurysms Maintains a Pivotal Role in the Endovascular Era

Abstract

Since the advent of endovascular aortic repair (EVAR) nearly three decades ago, there has been a paradigm shift in the treatment of the abdominal aortic aneurysm (AAA) to favor EVAR due to its reduced operative mortality, less invasive nature, and faster recovery times. However, more recently there has been an accumulation of data from large meta-analyses and randomized clinical trials revealing that EVAR has no survival benefit after approximately 2 years and is associated with substantially higher rates of reintervention and aneurysm rupture in the long term. These findings call into question the durability of EVAR compared with open aortic repair and emphasize the need for surgeons to remain competent with open aortic surgery in the modern era. This article will provide comprehensive review of a large body of literature comparing endovascular repair to open aortic surgery for the management of AAAs, and it will offer an overview of the open surgical repair technique for AAAs.

Surgical Treatment of Abdominal Aortic Aneurysms

“…Endovascular aneurysm repair has become a priority in vascular surgery and the main method of AAA treatment due to its ability to reduce procedure time, surgical complications, and length of hospital stay (2,6). As a result, it has significantly replaced open intervention techniques in the treatment of AAA (3,14).…”

“…Abdominal aortic aneurysm (AAA) is a ticking time bomb in the abdominal cavity of over 1 % of adults worldwide (1,2). Open surgical repair of AAAs is a major procedure with its own risks, while endovascular aneurysm repair (EVAR) has lower perioperative mortality but higher longterm complications and reintervention rates.…”

Surgical Treatment of Abdominal Aortic Aneurysms. A Retrospective Study.

“…et al, 2022). [2,6] As a it has significantly replaced open intervention techniques in the treatment of AAA (Witheford M et al, 2022;Dansey K.D et al, 2021). [3,14] a retrospective cohort study (Kinio A. et al,[17] treatment of recurrent aaa is usually tricky, and perioperative mortality in such cases is significantly increased compared with primary treatment (Sakalihasan N.…”

Cost-effectiveness analysis of endovascular versus open repair in patients with abdominal aortic aneurysm in Iran: a cross-sectional study

“…Based on the results of the studies, the effectiveness of the EVAR method in the short-term is relatively one step ahead of the OSR method. However, in the long-term, the effectiveness of these two methods has been almost similar 22 , 23 .…”