Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.0118
Jornal Vascular Brasileiro
Original Article

Open vs. endovascular repair of abdominal aortic aneurysm: a comparative analysis

Análise comparativa entre tratamentos convencional e endovascular de aneurisma de aorta abdominal

Samuel de Paula Miranda; Paschoal Cunha Miranda; Marília Granzotto Volpato; Maria Cláudia Folino; Antônio Massamitsu Kambara; Fábio Henrique Rossi; Nilo Mitsuru Izukawa

http://dx.doi.org/10.1590/1677-5449.0118 J Vasc Bras, vol.13, n4, p.276-284, 2014
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Abstract

Context:Abdominal aortic aneurysm (AAA) is a condition that is usually asymptomatic, but potentially fatal, and has a prevalence in men over 60 years old ranging from 4.3% to 8%. There are two treatment options available: open surgery (OS) and endovascular treatment (ET).Objective:To compare the results of repairs conducted using these two treatment methods from 2008 to 2013 in a tertiary hospital.Methods:A retrospective analysis comparing 119 patients treated with OS and 219 patients who underwent ET for AAA repair.Results:The ET group was older (71.3 vs. 68.2 years; p<0.001) and had a higher rate of coronary disease (44.7% vs. 27.7%; p=0.002) and a lower ejection fraction (57.6% vs. 64.3%; p<0.001); in turn, the OS group had more chronic obstructive pulmonary disease (16.0% vs. 5.9%; p=0.004) and a smaller proximal infrarenal neck (15.5 mm vs. 23.0 mm; p<0.001). However, there was no difference in ASA classification (American Society of Anesthesiology) (p=0.36). The ET group had less intraoperative bleeding (171 mL vs. 729 mL; p<0.001) and required fewer blood transfusions (11.9% vs. 73.1% p<0.001), and spent shorter stays in both ICU (2.4 vs. 3.5 days; p=0.002) and hospital (5.8 vs. 10.3 days; p<0.001). Thirty-day mortality was similar (OS 5.0% vs. ET 4.1%; p=0.78) and there was also no difference in postoperative complications. The average cost of ET was higher (R$34,277.76 vs. R$4,778.60; p<0.001).Conclusions:Rates of morbidity and mortality were similar, although ET was associated with less bleeding, fewer transfusions and shorter hospital stays, but was more expensive.

Keywords

abdominal aortic aneurysm, vascular surgical procedures, endovascular procedures

Resumo

Contexto:O aneurisma de aorta abdominal (AAA) é uma condição frequentemente assintomática, porém potencialmente fatal, cuja prevalência em homens com 60 anos ou mais está entre 4,3% e 8%. Existem duas modalidades de tratamento disponíveis: cirurgia aberta (TA) e endovascular (TE).Objetivo:Comparar os resultados dessas duas modalidades de tratamento, entre 2008 e 2013, em um hospital terciário.Métodos:Análise retrospectiva comparando 119 pacientes submetidos ao TA e 219 pacientes submetidos ao TE, para correção de AAA.Resultados:O grupo submetido ao TE apresentou maior idade (71,3 vs. 68,2 anos; p<0,001) e doença coronariana (44,7% vs. 27,7%; p=0,002), além de menor fração de ejeção (57,6% vs. 64,3%; p<0,001); por sua vez, o grupo submetido ao TA exibiu mais doença pulmonar obstrutiva crônica (16,0% vs. 5,9%; p=0,004) e menor colo proximal infrarrenal (15,5 mm vs. 23,0 mm; p<0,001). Entretanto, não houve diferença na classificação ASA (American Society of Anesthesiology) (p=0,36). O grupo de TE apresentou menor sangramento intraoperatório (171 mL vs. 729 mL; p<0,001), com menor necessidade de hemotransfusão (11,9% vs. 73,1% p<0,001), menor permanência em UTI (2,4 vs. 3,5 dias; p=0,002) e menor tempo de internação hospitalar (5,8 vs. 10,3 dias; p<0,001). A mortalidade em 30 dias foi semelhante (TA 5,0% vs. TE 4,1%; p=0,78), também não havendo diferença nas complicações pós-operatórias. O custo médio do TE foi maior (R$34.277,76 vs. R$4.778,60; p<0,001).Conclusão:As taxas de morbimortalidade foram semelhantes, sendo no TE o sangramento, a necessidade transfusional e a duração da internação hospitalar menores, porém com custo mais elevado.

Palavras-chave

aneurisma de aorta abdominal, procedimentos cirúrgicos vasculares, procedimentos endovasculares

References

Moll FL, Powell JT, Fraedrich G. Management of abdominal aortic aneurysms clinical practice guidelines of the European society for vascular surgery. Eur J Vasc Endovasc Surg. 2011;41(41^s1):S1-S58.

Puech-Leafio P, Molnar LJ, Oliveira IR, Cerri GG. Prevalence of abdominal aortic aneurysms: a screening program in Safio Paulo, Brazil. Sao Paulo Med. J. 2004;122(4):158-60.

Gupta PK, Ramanan B, Lynch TG. Endovascular repair of abdominal aortic aneurysm does not improve early survival versus open repair in patients younger than 60 years. Eur J Vasc Endovasc Surg. 2012;43(5):506-12.

Greenhalgh RM, Powell JT. Endovascular repair of abdominal aortic aneurysm. N Engl J Med. 2008;358(5):494-501.

Lederle FA. Abdominal aortic aneurysm—open versus endovascular repair. N Engl J Med. 2004;351(16):1677-9.

Prinssen M, Verhoeven EL, Buth J. A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med. 2004;351(16):1607-18.

Mendonça CT, Moreira RCR, Timi JRR. Comparação entre os tratamentos aberto e endovascular dos aneurismas de aorta abdominal em pacientes de alto risco cirúrgico. J Vasc Bras. 2005;4(3):232-42.

Rossi FH. Pós-Operatório Hospitalar na Cirurgia Vascular e Endovascular. Condutas Terapêuticas do Instituto Dante Pazzanese de Cardiologia. Atheneu. 2006;1:6.

Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg. 1991;5(6):491-9.

Moulakakis KG, Dalainas I, Kakisis J, Mylonas S, Liapis CD. Endovascular Treatment versus Open Repair for Abdominal Aortic Aneurysms: The Influence of Fitness in Decision Making. Int J Angiol. 2013;22(1):9-12.

Becquemin JP, Pillet JC, Lescalie F. A randomized controlled trial of endovascular aneurysm repair versus open surgery for abdominal aortic aneurysms in low- to moderate-risk patients. J Vasc Surg. 2011;53(5):1167-73.

Sandford RM, Choke E, Bown MJ, Sayers RD. What is the best option for elective repair of an abdominal aortic aneurysm in a young fit patient?. Eur J Vasc Endovasc Surg. 2014;47(1):13-8.

Greenhalgh RM, Brown LC, Powell JT, Thompson SG, Epstein D. Endovascular repair of aortic aneurysm in patients physically ineligible for open repair. N Engl J Med. 2010;362(20):1872-80.

Brown LC, Epstein D, Manca A, Beard JD, Powell JT, Greenhalgh RM. The UK Endovascular Aneurysm Repair (EVAR) trials: design, methodology and progress. Eur J Vasc Endovasc Surg. 2004;27(4):372-81.

Lederle FA, Freischlag JA, Kyriakides TC. Outcomes following endovascular vs open repair of abdominal aortic aneurysm: a randomized trial. JAMA. 2009;302(14):1535-42.

Greenhalgh RM, Brown LC. Endovascular versus open repair of abdominal aortic aneurysm. N Engl J Med. 2010;362(20):1863-71.

Giles KA, Landon BE, Cotterill P, O'Malley AJ, Pomposelli FB, Schermerhorn ML. Thirty-day mortality and late survival with reinterventions and readmissions after open and endovascular aortic aneurysm repair in Medicare beneficiaries. J Vasc Surg. 2011;53(1):6-13.

Qadura M, Pervaiz F, Harlock JA. Mortality and reintervention following elective abdominal aortic aneurysm repair. J Vasc Surg. 2013;57(6):1676-83.

Antonello M, Menegolo M, Piazza M, Bonfante L, Grego F, Frigatti P. Outcomes of endovascular aneurysm repair on renal function compared with open repair. J Vasc Surg. 2013;58(4):886-93.

Biancari F, Catania A, D'Andrea V. Elective endovascular vs. open repair for abdominal aortic aneurysm in patients aged 80 years and older: systematic review and meta-analysis. Eur J Vasc Endovasc Surg. 2011;42(5):571-6.

Raval MV, Eskandari MK. Outcomes of elective abdominal aortic aneurysm repair among the elderly: endovascular versus open repair. Surgery. 2012;151(2):245-60.

de la Motte L, Jensen LP, Vogt K, Kehlet H, Schroeder TV, Lonn L. Outcomes after elective aortic aneurysm repair: a nationwide Danish cohort study 2007-2010. Eur J Vasc Endovasc Surg. 2013;46(1):57-64.

Adriaensen ME, Bosch JL, Halpern EF, Myriam Hunink MG, Gazelle GS. Elective endovascular versus open surgical repair of abdominal aortic aneurysms: systematic reviewof short-term results. Radiology. 2002;224(3):739-47.

Carpenter JP, Baum RA, Barker CF. Impact of exclusion criteria on patient selection for endovascular abdominal aortic aneurysm repair. J Vasc Surg. 2001;34(6):1050-4.

Min SI, Min SK, Ahn S. Comparison of costs of endovascular repair versus open surgical repair for abdominal aortic aneurysm in Korea. J Korean Med Sci. 2012;27(4):416-22.

Morimae H, Maekawa T, Tamai H. Cost disparity between open repair and endovascular aneurysm repair for abdominal aortic aneurysm: a single-institute experience in Japan. Surg Today. 2012;42(2):121-6.

Prinssen M, Buskens E, Jong SE. Cost-effectiveness of conventional and endovascular repair of abdominal aorticaneurysms: results of a randomized trial. J Vasc Surg. 2007;46(5):883-90.

Stroupe KT, Lederle FA, Matsumura JS. Cost-effectiveness of open versus endovascular repair of abdominal aortic aneurysm in the OVER trial. J Vasc Surg. 2012;56(4):901-909.e2.

Schermerhorn ML, O'Malley AJ, Jhaveri A, Cotterill P, Pomposelli F, Landon BE. Endovascular vs. open repair of abdominal aortic aneurysms in the Medicare population. N Engl J Med. 2008;358(5):464-74.

Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): randomised controlled trial. Lancet. 2005;365(9478):2179-86.

Becquemin JP. The ACE trial: a randomized comparison of open versus endovascular repair in good risk patients with abdominal aortic aneurysm. J Vasc Surg. 2009;50(1):222-4.

Blankensteijn JD, Jong SE, Prinssen M. Two-year outcomes after conventional or endovascular repair of abdominal aortic aneurysms. N Engl J Med. 2005;352(23):2398-405.

Schermerhorn ML, Finlayson SR, Fillinger MF, Buth J, van Marrewijk C, Cronenwett JL. Life expectancy after endovascular versus open abdominal aortic aneurysm repair: results of a decision analysis model on the basis of data from EUROSTAR. J Vasc Surg. 2002;36(6):1112-20.

De Bruin JL, Baas AF, Buth J. Long-term outcome of open or endovascular repair of abdominal aortic aneurysm. N Engl J Med. 2010;362(20):1881-9.

Chadi SA, Rowe BW, Vogt KN. Trends in management of abdominal aortic aneurysms. J Vasc Surg. 2012;55(4):924-8.

Verhoeven EL, Prins TR, Tielliu IF. Treatment of short-necked infrarenal aortic aneurysms with fenestrated stent-grafts: short-term results. Eur J Vasc Endovasc Surg. 2004;27(5):477-83.

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