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Repair of Abdominal Aortic Aneurysms: The Benefits of Offering Both Endovascular and Open Surgical Techniques

Department of Vascular Surgery (HT, PP, IH, JN, GK); Department of Angiography and Interventional Radiology (JL), Medical University of Vienna, Austria

Peter Polterauer, MD

Department of Vascular Surgery (HT, PP, IH, JN, GK); Department of Angiography and Interventional Radiology (JL), Medical University of Vienna, Austria; Department of Vascular Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria peter.polterauer{at}meduniwien.ac.at

Johannes Lammer, MD

Ihor Huk, MD

Josif Nanobachvili, MD

Georg Kretschmer, MD

Department of Vascular Surgery (HT, PP, IH, JN, GK); Department of Angiography and Interventional Radiology (JL), Medical University of Vienna, Austria

Two treatment options are available for abdominal aortic aneurysms (AAAs): open surgical technique with graft replacement and endovascular aortic aneurysm repair (EVAR) as a minimally invasive procedure. The intention of this review is to highlight the advantages of both procedures and to demonstrate that offering both procedures is beneficial for the patient when he or she makes the important decision regarding which treatment to select. A comparative evaluation of both treatment options is offered as well as a short description of the risk of rupture and its consequences. The authors discuss the latest literature as well as their own experiences. An innovative statistical approach—the propensity score–based Cox model—is presented to evaluate the 2 treatment options. The benefits of offering both EVAR and open surgery permit optimal management of AAA for the individual patient and tailor the treatment to his or her organ dysfunctions and impaired physical status. In addition, EVAR offers a treatment option for otherwise incurable high-risk patients.

Key Words: abdominal aortic aneurysm • endovascular repair • surgery

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