Endovascular Versus Open Repair for Symptomatic, Non-Ruptured Abdominal Aortic Aneurysms: A Retrospective Cohort Study

Wanchai Chinchalongporn; Pitchaya  Wisantanon; Khamin Chinsakchai; Chanean  Ruangsetakit; Chumpol  Wongwanit; Kiattisak  Hongku; Sasima  Tongsai; Nuttawut  Sermsathanasawadi; Suteekhanit  Hahtapornsawan; Nuttawut  Pungpunngam; Tossapol  Prapassaro; Kanin  Pruekprasert

doi:10.33192/smj.v77i11.277132

Authors

Wanchai Chinchalongporn Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Pitchaya Wisantanon Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Khamin Chinsakchai Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Chanean Ruangsetakit Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Chumpol Wongwanit Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Kiattisak Hongku Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Sasima Tongsai Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Nuttawut Sermsathanasawadi Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Suteekhanit Hahtapornsawan Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Nuttawut Pungpunngam Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Tossapol Prapassaro Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Kanin Pruekprasert Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand

DOI:

https://doi.org/10.33192/smj.v77i11.277132

Keywords:

Abdominal aortic aneurysm, symptomatic, non-ruptured, endovascular repair, open repair, perioperative outcomes, survival analysis

Abstract

Objective: To compare perioperative organ morbidity, 30-day mortality, and 5-year overall survival following endovascular aneurysm repair (EVAR) versus open surgical repair (OSR) for symptomatic, non-ruptured abdominal aortic aneurysm (SnAAA).

Materials and Methods: We retrospectively reviewed 140 consecutive patients treated for SnAAA between 2010 and 2020 (EVAR n=111, OSR n=29). The primary endpoint was 30-day all-cause mortality; secondary endpoints included perioperative complications and 5-year survival. Due to extreme baseline imbalances (62.2% unfit in EVAR vs 6.9% in OSR) and limited sample size, multivariable adjustment was used instead of propensity score methods.

Results: Thirty-day mortality was 1.8% in the EVAR group and 3.4% in the OSR group (p=0.504, Fisher’s exact test). EVAR was associated with an 88% reduction in perioperative organ complications (adjusted OR 0.12, 95% CI 0.03-0.47, p=0.003), including a significant reduction in respiratory failure (2.7% vs 13.8%, OR 0.17, 95% CI 0.04-0.83, p=0.034). EVAR also resulted in shorter operative time (median 150 vs 265 minutes, p<0.001), reduced blood loss (200 vs 1,800 mL, p<0.001), and shorter hospital stay (7 vs 11 days, p<0.001). Five-year survival analysis revealed no significant difference between groups (log-rank p=0.193; adjusted HR 1.09, 95% CI 0.42-2.85, p=0.857).

Conclusions: Despite being performed in a higher-risk cohort, EVAR provided significant protection against organ complications without compromising long-term survival compared to OSR. These findings support EVAR as the preferred approach for unfit patients with SnAAA, while both strategies remain appropriate options for fit patients.

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