Changing Trends in the Treatment of AAA: Analysis of Volume, Technique and Outcome

Purpose: Over the past three decades, treatment of abdominal aortic aneurysm (AAA) disease has undergone an evolution. In this study we evaluate our volume and outcome of patients presenting with AAA who were repaired either by various open or endovascular techniques and compare the outcomes.
Methods: Since 1981, data was prospectively collected in our vascular registry and all patients undergoing elective and emergent AAA repair were included. Although from 1981-1985 our preferred technique for open surgical repair was transabdominal, the retroperitoneal approach was adopted in 1986. Endovascular techniques for AAA repair (EVAR) were adopted in 1996, and since 2001 EVAR has become the primary technique for treating infrarenal AAA. Data was analyzed for risk factors and outcomes of transabdominal, retroperitoneal, and endovascular AAA repair.
Results: Since 1981, 4025 patients underwent elective (3380, 84%) and emergent (645, 16%) treatment of AAA via transabdominal (247, 6%), retroperitoneal (3009, 75%), and endovascular (769, 19%) techniques. Analysis of patients treated in 5 year blocks from 1981-2005 indicates a significant rise in volume from 297 in 1981-1985 to 1354 in 2001 - 2005 as well as a significant rise in risk factors, and a decrease in mortality (9.1% to 4.8%). Patients undergoing EVAR had a higher incidence of CAD, hypertension, and COPD. The overall mortality of elective aneurysm repair was 2.4%, (2.8% for open and 1.1 % for endovascular).
Conclusion: The volume of AAA procedures performed over the past 25 years has increased. With the advent of EVAR the mortality has decreased. However, the complexity of the open procedures has increased.