A Retrospective Study Of Open Surgery Versus Endovascular Aneurysm Repair For Infrarenal Abdominal Aortic Aneurysm

Objective To summarize our clinical experience of traditional open surgery (OS) and endovascular aneurysm repair (EVAR) for infrarenal abdominal aortic aneurysm (AAA). Further understanding of the operative indications and perioperative period principles of the two surgery methods, and provide a theoretical basis for individual therapy.Methods Retrospective analysis the clinical data and follow-up data of47cases underwent abdominal aortic aneurysm resection and artificial vascular replacement (OS group) and21cases received endovascular aneurysm repair (EVAR group) during January2003and January2012. Collect the information of operation time, aortic cross-clamp time, bleeding and blood transfusion volume, postoperative drainage volume, ICU residence time, postoperative hospital stay, the total cost of hospitalization and complications and death during perioperative and follow-up period. Summarize the treatment details during perioperative period of the different operation methods. The results were analyzed by statistical software.Results The ratio of onset symptom as gastrointestinal discomfort were44.7%(OS group, n=21) and14.3%(EVAR group, n=3), with statistical difference. The two groups of operation time, aortic cross-clamp time, bleeding and blood transfusion volume, postoperative drainage volume, ICU residence time, postoperative hospital stay and the total cost of hospitalization were (3.5±1.2)h vs (2.1±0.75)h,(56.0±11.1) min vs Omin,(270±60)ml vs (60±30) ml,(100±40)ml vs0ml,(125±60)ml vs0ml,(55±12) h vs (18±9)h,(14.8±3.5)d vs (7.5±2.5)d and (54±15)thousand RMB vs (144±16) thousand RMB, respectively, with statistically differences. Two groups of perioperation period main complication rate and mortality rate were29.8%(OS group, n=14) and28.6%(EVAR group, n=6),4.3%(OS group, n=2) and4.8%(EVAR group, n=1), with no significant difference. There was significant difference of long-term complication rate between the two groups (P<0.01), while the two groups of follow-up survival results were similar.Conclusion Traditional OS for infrarenal AAA has short-term complications mainly as gastrointestinal discomfort and pneumonia, few long-term complications and no recurrence. EVAR has the advantages as short operation time, low bleeding and blood transfusion volume, fast postoperative recovery, however, the postoperative heart failure risk EVER is higher than OS, with a lower cost-efficiency. EVAR may not be used as a general option in place of traditional OS.