endovascular repair versus open repair of aneurysms

Last edited 03/2020

endovascular repair vs open surgical repair of aneurysms

Potential advantages of endovascular aneurysm repair (EVAR) over open surgical repair (OSR) include:

• reduced time under general anaesthesia
• elimination of the pain and trauma associated with major abdominal surgery
• reduced length of stay in the hospital and intensive care unit (ICU)
• reduced blood loss

Potential disadvantage are:

•  development of endovascular leaks (endoleaks), which occur when blood continues to flow through the aneurysm because the graft does not seal completely (type I endoleak) or because of backfilling of the aneurysm from other small vessels in the aneurysm wall (type II endoleak)
• patients who have had  OSR do not require any special follow-up, but patients who have undergone EVAR may require computed tomography (CT) or ultrasound scans to check for the presence of late-occurring endoleaks
• if EVAR is unsuccessful or complications arise during the procedure, conversion to OSR may be necessary even in patients initially considered unfit for open surgery (1)

Open surgical repair, standard endovascular aneurysm repair or conservative management (2):

• open surgical repair should be offered for people with unruptured AAAs meeting the criteria * unless it is contraindicated because of their abdominal copathology, anaesthetic risks, and/or medical comorbidities
• consider endovascular aneurysm repair (EVAR) for people with unruptured AAAs who meet the criteria * and who have abdominal copathology, such as a hostile abdomen, horseshoe kidney or a stoma, or other considerations, specific to and discussed with the person, that may make EVAR the preferred option
• consider EVAR or conservative management for people with unruptured AAAs meeting the criteria * who have anaesthetic risks and/or medical comorbidities that would contraindicate open surgical repair

* Consider aneurysm repair for people with an unruptured abdominal aortic aneurysm (AAA), if it is:

• symptomatic
• asymptomatic, larger than 4.0 cm and has grown by more than 1 cm in 1 year (measured inner-to-inner maximum anterior-posterior aortic diameter on ultrasound)
• asymptomatic and 5.5 cm or larger (measured inner-to-inner maximum anterior-posterior aortic diameter on ultrasound)

Reference:

• NICE (February 2009). Endovascular stent-grafts for the treatment of abdominal aortic aneurysms
• NICE (March 2020).Abdominal aortic aneurysm: diagnosis and management