Standard open surgical repair versus endovascular repair of anastomotic abdominal aortic aneurysms

Background. The Study Aimed To compare the endovascular stent-graft technique with open repair of anastomotic aortic aneurysms following aorto-femoral reconstructions. Methods. Nine patients (mean age = 62.7 years; ASA II: 5 patients, ASA III: 3 patients ASA IV: 1 patient) were treated with standard open repair (group 1) and 14 patients at high surgical risk (mean age=71.8 years; ASA II: 2 patients, ASA III: 3 patients, ASA IV: 9 patients) were treated by endovascular stent-grafting (group II), in both groups for non-infected anastomotic aneurysms located in the abdominal aorta. One patient in the surgical group had frank and 1 had covered rupture of the aneurysm sac. In addition, 1 anastomotic iliac aneurysm was excluded by means of a tube graft and 7 anastomotic femoral aneurysms were repaired by surgery. Results. Surgical treatment was resection of the anastomotic aortic aneurysm and replacement with a new graft. The operative morbidity rate was 25%; mortality rate 14.3% (1 out of 7) for patients with intact aneurysm and 50% (1 of 2) for patients with ruptured aneurysm. All endovascular interventions were completed satisfactorily, with no open conversion; an acute graft thrombosis occurred in 1 patient (7.1%), who required a femoro-femoral crossover graft. There were no procedure-related deaths, and complications (14.3%) included 1 perioperative transient cerebral ischemia and 1 case of postoperative jaundice. During a mean follow-up period of 3.8 years (14-81 months) and 4.3 years (11-79 months), respectively, re-operation has been required in 14.3 % of patients after standard operative repair and in 21.4% after endovascular repair for treatment of limb occlusion or graft migration. There was 1 late conversion to open repair 46 months after the initial procedure. The late mortality rates were almost identical (28.6 % versus 21.4%) in the two groups. Conclusions. Endoluminal repair is a less invasive treatment method and provides benefits to elderly, high-risk patients. Because of concerns related to its long-term effectiveness, elective standard surgical repair can still play a role for younger, lower-risk patients.