Endovascular Versus Open Repair for Symptomatic, Non-Ruptured Abdominal Aortic Aneurysms: A Retrospective Cohort Study
1
Issued Date
2025-11-01
Resource Type
eISSN
22288082
Scopus ID
2-s2.0-105020651036
Journal Title
Siriraj Medical Journal
Volume
77
Issue
11
Start Page
777
End Page
789
Rights Holder(s)
SCOPUS
Bibliographic Citation
Siriraj Medical Journal Vol.77 No.11 (2025) , 777-789
Suggested Citation
Chinchalongporn W., Wisantanon P., Chinsakchai K., Ruangsetakit C., Wongwanit C., Hongku K., Tongsai S., Sermsathanasawadi N., Hahtapornsawan S., Pungpunngam N., Prapassaro T., Pruekprasert K. Endovascular Versus Open Repair for Symptomatic, Non-Ruptured Abdominal Aortic Aneurysms: A Retrospective Cohort Study. Siriraj Medical Journal Vol.77 No.11 (2025) , 777-789. 789. doi:10.33192/smj.v77i11.277132 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/112970
Title
Endovascular Versus Open Repair for Symptomatic, Non-Ruptured Abdominal Aortic Aneurysms: A Retrospective Cohort Study
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Corresponding Author(s)
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Abstract
Objective: To compare perioperative organ morbidity, 30-day mortality, and 5-year overall survival following endovascular aneurysm repair (EVAR) versus open surgical repair (OSR) for symptomatic, non-ruptured abdominal aortic aneurysm (SnAAA). Materials and Methods: We retrospectively reviewed 140 consecutive patients treated for SnAAA between 2010 and 2020 (EVAR n=111, OSR n=29). The primary endpoint was 30-day all-cause mortality; secondary endpoints included perioperative complications and 5-year survival. Due to extreme baseline imbalances (62.2% unfit in EVAR vs 6.9% in OSR) and limited sample size, multivariable adjustment was used instead of propensity score methods. Results: Thirty-day mortality was 1.8% in the EVAR group and 3.4% in the OSR group (p=0.504, Fisher’s exact test). EVAR was associated with an 88% reduction in perioperative organ complications (adjusted OR 0.12, 95% CI 0.03-0.47, p=0.003), including a significant reduction in respiratory failure (2.7% vs 13.8%, OR 0.17, 95% CI 0.04-0.83, p=0.034). EVAR also resulted in shorter operative time (median 150 vs 265 minutes, p<0.001), reduced blood loss (200 vs 1,800 mL, p<0.001), and shorter hospital stay (7 vs 11 days, p<0.001). Five-year survival analysis revealed no significant difference between groups (log-rank p=0.193; adjusted HR 1.09, 95% CI 0.42-2.85, p=0.857). Conclusions: Despite being performed in a higher-risk cohort, EVAR provided significant protection against organ complications without compromising long-term survival compared to OSR. These findings support EVAR as the preferred approach for unfit patients with SnAAA, while both strategies remain appropriate options for fit patients.