Aortic aneurysm - endovascular repair vs open surgery: systematic literature review

Abstract

Background: Abdominal aortic aneurysm is a pathology with a prevalence in men over 65 years of age of more than 8% worldwide. It has a high mortality and morbidity rate, representing between 1 and 2% of deaths. When surgical repair is indicated there are two options, endovascular repair and open abdominal surgery. Endovascular repair in elective patients seems to be the best option as it is a less invasive method, although so far there is no conclusive evidence on the advantages in certain subgroups. On the other hand, open surgery, taking into account the anatomy, age and context of the patient, could be more beneficial in certain groups. In conclusion, the choice of the therapeutic method in an elective situation will depend on the individual context of each patient, considering the possible complications and reinterventions that may affect the quality of life and put the patient's life at risk.  Material and methods: An in-depth literature search will be performed in the PubMed database, using inclusion and exclusion criteria, and filters in the last ten years where randomized clinical trial studies, case-control studies and systematic reviews will be evaluated. Always using the following search terms: "abdominal aortic aneurysm", "endovascular repair" and "open abdominal surgery".  Results: Six studies were selected after applying the inclusion and exclusion criteria. The articles compared and analyzed the use of endovascular repair (EVAR) and open surgical repair (OSR). Both methods were evaluated and compared using the variables of short- and long-term complications and the rate of reinterventions. It was found that patients who received EVAR had a higher rate of total complications with a high predominance after 4 years post intervention. As for reinterventions, there was a significantly higher rate in those who received EVAR with respect to those who underwent OSR.  Conclusion: Endovascular repair showed a higher rate of reinterventions than open surgery. As well as a greater number of long-term complications. These are results that should be taken into account when evaluating it as a therapeutic option, especially in certain groups of patients. Thus, open surgery appears to be a safer treatment. Especially in the long term and in groups of young patients without comorbidities