Open versus endovascular repair of para-anastomotic aneurysms in patients who were morphological candidates for endovascular treatment.

ABSTRACT

PURPOSE: To compare the outcomes of open versus endovascular repair of para-anastomotic aneurysms (PAA) in the aortic and iliac arteries in a cohort of patients who fulfilled morphological criteria for endovascular repair. METHODS: A retrospective review of 31 consecutive patients with PAA treated between 1985 and 2002 identified 26 (84%) patients who would have been candidates for endovascular repair based on preoperative computed tomography and angiography. Of these 26 patients, 10 (9 men; median age 65 years, range 60-75) underwent endovascular repair; the remaining 16 patients (14 men; median age 61.5 years, range 49-78) had open repair. The baseline data and outcome measures were compared between the treatment groups. RESULTS: The patient groups were well matched for age, sex, weight, risk factors, comorbidities, aneurysm length, and elapsed time from initial graft placement. Both groups had technically successful PAA repairs; however, median blood loss (300 versus 1000 mL; p=0.05) and procedural time (100 versus 215 minutes; p<0.001) were significantly reduced in the endovascular group. Median transfusion volume was significantly greater (1000 versus 0 mL; p=0.01) in the surgically treated patients. The median stay in ICU was similar (18 versus 24 hours in the surgical cohort). Length of stay was significantly shorter in the endovascular group 7.5 versus 17.0 days (p=0.001) after the repair and 11 versus 22 days (p=0.01) for overall hospitalization. One (10%) patient in the endovascular group died from a myocardial infarction on the third postoperative day. In the open group, there were 3 (19%) procedure-related deaths. CONCLUSIONS: Patients with PAA who were endograft candidates but who were treated with open repair experienced more morbidity and had more complications than patients treated with stent-grafts. If long-term follow-up demonstrates durable results, stent-graft repair may become the therapy of choice in PAAs.