1Mohamed Rizk

1Faculty of medicine, Ain Shams university

Background(s):

Abdominal aortic aneurysm is a serious condition that can affect the life of the patient. It is treated when the size of the aneurysm reaches a cut value of 5.5 cm. dealing with AAA is either with open surgical repair which carries significant morbidity and mortality, or it can be done using a minimally invasive technique using an endograft (EVAR). This new technique is a demanding procedure, and these demands may not be met in all patients, noncompliance with these demands may lead to reintervention and increased risk of rupture

Material(s) and Method(s):

This were a retrospective study which included 61 patients from the period of December 2014 till December 2020. We included male or female patients presenting for elective repair of infrarenal abdominal aortic aneurysm (AAA) or having pain or leakage but not free rupture. According to the intervention method, patients were divided into two groups. Group (A): patients who underwent open surgical repair, group (B): patients who underwent endovascular aortic aneurysm repair (EVAR).

Result(s):

There was no significant difference between both groups as regard the demographic data except for age (P=0.0026). As regard the indication for intervention, there was no statistical difference (P=0.4881). there was a high statistical difference between both groups as regard the size of the aneurysm (P<0.0001). Patients in the surgical group have had general or combined general/ epidural, while patients in the EVAR group underwent the procedure using local or locoregional anesthesia. Intraoperative mortality in the surgical group was 4.65% versus non in the EVAR group. The operative time is significantly decreased in the EVAR group in relation to the surgical group (P< 0.0001). The postoperative mortality in the surgical group was 4.9% compared to 0% in the EVAR group (P=1.0000). The total hospital stay was found to be 8.9024 ± 1.9976 days in surgical group, while in the EVAR group it was 4.5 ± 0.9574 days with a P value of < 0.0001.

Conclusion(s):

Open surgical approach for managing AAA was associated with increased perioperative mortality and morbidity with increased hospital stay while EVAR was associated with less rates of perioperative morbidity and mortality but with increased rates of reintervention and late rupture, especially with non-adherence to the indications of use. Managing an AAA with either open surgical approach or EVAR must be tailored according to the patient’s comorbid condition and anatomical suitability.