Minimal Incision Aortic Aneurysm Repair Compared to Standard Open and Endovascular Repair: Is it the new gold standard?

OBJECTIVES: To determine if minimal incision aortic repair (MIAR) for abdominal aortic aneurysm (AAA) is superior to traditional open surgery (OR) or endovascular repair (EVAR).
METHODS: Data of 192 consecutive patients (November 2002 - July 2006) who underwent elective infrarenal AAA repair by MIAR (incision <15 cm, n=64), OR (n=65) or EVAR (n=63) were reviewed. Patient characteristics, 30-day mortality and complications rates were compared with Pearson chi-square test. Survival was assessed using Kaplan-Meier curves and Log Rank p-value.
RESULTS: EVAR patients (mean 75.6 years) were older than MIAR (72.8 years) or OR (71.2 years) (p=0.002) patients. Compared to MIAR or OR, EVAR patients had more frequent positive cardiac stress tests (p=0.06), previous myocardial infarctions (p=0.008) and lung disease (p=0.05). 30-day major complication rates and mortality rates for MIAR, OR and EVAR were 5%, 15%, 5% (p=0.15) and 1.7%, 1.6% and 1.6% (p=0.99) respectively. The >30-day complication rate for MIAR was 5%; OR 12.5% (p=0.2). The 30 to 180-day and >180-day EVAR re-intervention rate for endoleak and/or migration was 4.7% (3/63) and 6.3% (4/63). Median length of stay (LOS) was shorter in MIAR=5 d (3-43) compared to OR=7 d (4-12) (p=0.003), however, longer compared to EVAR=2 d (1-40); (p< .001). Median total hospital charges for MIAR were similar to OR, with OR charges +$1,325 greater than MIAR (p=0.32). EVAR charges were +$15,305 more than MIAR (p<0.001). Three-year survival was 91%, 87%, and 81% (p=0.35) for MIAR, OR and EVAR.
CONCLUSIONS: Despite being older and having more cardiopulmonary risk factors, EVAR patients have similar mortality and major complications as MIAR or OR with higher hospital charges. MIAR is as safe as OR and results in a shorter LOS.