Reasons for and Outcomes of Open Abdominal Aortic Repair in the Endovascular Era.

Abstract Background Endovascular aortic aneurysm repair (EVAR) has become the treatment of choice for most patients with abdominal aortic aneurysm (AAA). Open aneurysm repair (OAR) is still being used in a number of patients for specific reasons. The aim of the present study was to investigate the reasons and perioperative outcomes of OAR in a high-volume endovascular center. Methods All patients that underwent OAR in a single center institution during the period April 2010 to July 2019 were retrospectively analyzed. Results During the study period 222 patients underwent OAR. One hundred and forty-one (63.5%) patients underwent elective surgery and eighty-one (36.5%) patients were treated acutely. The reasons for the decision to perform OAR instead of EVAR were as follows: anatomical in 89 (40.1%) cases, rupture in unstable patient in 57 (25.7%) cases, AAA with concomitant iliac arterial occlusive disease in 44 (19.8%) cases, previous EVAR with complications in 14 (6.3%) cases, large pararenal aneurysm considered risky to wait for a customized fenestrated stent-graft in 7 (3.2%) cases, young patient age in 4 (1.8%) cases, patient’s preference in 3 (1.4%) cases, infected/mycotic AAA in 2 (0.9%) cases, and simultaneous OAR with colon cancer resection (n=1, 0.5%) and renal transplantation (n=1, n=0.5). Thirty-day mortality in elective cases was 5% (7/141), and in acute cases 34.6% (28/81) Conclusions This study shows that OAR is still used for selected patients despite improvements in EVAR technology. The most common reason for OAR was an unsuitable anatomy for EVAR. Perioperative mortality of OAR both for acute and elective cases as observed in this study is in line with published outcomes of other centers.