Australia & New Zealand Society of Vascular Surgeons

Objectives The objectives of this study were to determine potential differences in outcome between EVAR and conventional repair, and also to find out what was the exact influence of the introduction of EVAR on those that were conventionally treated thereafter. Patients and Methods Consecutive patients who underwent elective and primary EVAR (n=93) between April 1998 and January 2003, and conventional transabdominal aneurysm repair (TAAR) in the time periods before (TAAR-1; n=113) and after (TAAR-2; n=82) the introduction of EVAR were compared. Patient survival was calculated by the Kaplan Meier method and the possible predictive value of 30 different perioperative variables on 5 outcome variables (ICU time; morbidity; 30-d, 6-mth, and total mortality) was assessed by Cox’s proportional hazard model. Results There were no relevant differences in risk profiles between the three groups. All 5 outcome variables were significantly better with EVAR compared to TAAR-1 and TAAR-2, while the same accounts for TAAR-1 patients compared to TAAR-2 (p<0.05). The only distinct factors predictive for failure were the performance of an additional procedure and female gender for TAAR-1 patients and the preoperative use of acenocoumarol for TAAR-2 patients. Conclusion EVAR offers considerable benefits compared to TAAR at short and midterm follow-up, which is not caused by selection of patients with a favourable risk profile. In the current EVAR era, TAAR patients are being selected as the consequence of unfavourable anatomy. This strategy has as a distinct factor resulted in an increase of morbidity and mortality in the conventional open treatment of AAA.