Vascular diseases: Clinical-surgical intervention in abdominal aortic aneurysms

Abstract

Introduction: Abdominal aortic aneurysms (AAA) are dangerous dilatations of the aorta that, if left untreated, can lead to rupture and sudden death. The management of AAA has evolved with the development of techniques such as endovascular repair (EVAR) and open surgical repair. This study systematically reviews the efficacy, benefits, and limitations of each approach to determine the most appropriate intervention for different patient profiles. Methods: A systematic review was conducted in the PubMed, Scopus, and Cochrane Library databases from 2006 to 2024. Studies comparing EVAR and open surgical repair for mortality, complications, length of hospital stay, and quality of life were included. Methodological quality was assessed, and data were analyzed through narrative synthesis and meta-analysis when applicable. Results: We included 25 studies with 15,432 patients. EVAR demonstrated lower perioperative mortality (3.2% vs. 7.8%) and fewer immediate complications compared to open repair, in addition to shorter hospital stay (3.8 days vs. 7.2 days) and better short-term quality of life. However, EVAR had a greater need for long-term reinterventions (5.9% vs. 2.4%). Open repair showed greater durability with a lower rate of late complications. Conclusion: EVAR is advantageous for high-risk patients or those with comorbidities due to the immediate benefits. However, the greater need for reinterventions limits their long-term effectiveness. Open repair remains preferred for patients who are young or have proper anatomies due to its durability. The choice between the two techniques should be personalized, considering the patient's profile and characteristics of the aneurysm. Future studies should focus on improving the durability of endovascular devices and reducing EVAR complications.