Mortality Rates with Endovascular Repair of Aortic Aneurysm Similar to Open Repair

Perioperative morbidity and mortality rates are lower with endovascular repair of abdominal aortic aneurysm than with open repair, but long-term mortality rates are similar with both approaches, according to a new study in the New England Journal of Medicine.

“There is a substantial early advantage with endovascular repair in terms of death and complications, but late survival is similar and late rupture is higher with endovascular repair,” says lead study author Marc Schermerhorn, MD, chief of the Division of Vascular and Endovascular Surgery at Beth Israel Deaconess Medical Center and associate professor of surgery at Harvard Medical School in Boston.
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Schermerhorn and his colleagues assessed perioperative and long-term survival, reinterventions, and complications after endovascular repair as compared with open repair of abdominal aortic aneurysm in 39,966 matched pairs of Medicare beneficiaries.

Compared with open repair, endovascular repair had lower operative mortality (1.6% vs 5.6%), fewer complications, and shorter length of hospital stay. Patients were also more likely to go home after endovascular repair rather than to a rehab or a nursing home.

The early survival advantage with endovascular repair persisted for at least 3 years, after which survival was similar to open-repair outcomes all the way through 8 years of follow up. Periprocedural mortality was 1.6% with endovascular repair and 5.2% with open repair, but cumulative mortality in the study population was 50% at 8 years.

“Repeat interventions on the aneurysm were more common with endovascular repair while open surgery had more late complications related to the incision in the abdomen,” Schermerhorn says.

Rupture was more likely after endovascular repair and occurred in 5.4% of those who survived for 8 years vs 1.4% after open repair. However, Schermerhorn notes that the perioperative benefit of endovascular repair increased with age, and results with endovascular repair are improving over time.

“These results need to be viewed in context as we don’t have data regarding anatomy. However, it appears that for most patients an endovascular approach may be preferred,” Schermerhorn says. “The potential durability and risk for late rupture should be evaluated by the physician performing the procedure and steps to minimize the risk of late rupture should be taken.”

Next, Schermerhorn and his colleagues plan to evaluate which patients are at risk for late rupture and what steps can be taken to minimize this risk—whether it be open surgery upfront or changes to surveillance and reintervention after endovascular repair.

—Colleen Mullarkey

Reference

Schermerhorn ML, Buck DB, O’Malley AJ, Curran T, McCallum JC, Darling J, et al. Long-term outcomes of abdominal aortic aneurysm in the Medicare population. 2015 Jul 23;373(4):328-38.