What are the 30‑day mortality, major cardiac, stroke, pulmonary, wound complication, reintervention, and 5‑year survival rates for elective abdominal aortic aneurysm (AAA) repair comparing endovascular aneurysm repair (EVAR) and open surgical repair in typical adult patients?

Statistics on Elective Abdominal Aortic Aneurysm Repair

For elective AAA repair, EVAR demonstrates perioperative mortality <1% compared to 4-5% for open repair, but EVAR requires higher reintervention rates (14-29% endoleak incidence) and carries increased risk of late rupture after 8 years, while open repair shows approximately one-third of patients experiencing major complications but superior long-term durability. 1

30-Day Mortality Rates

EVAR:

• Perioperative mortality: <1% in contemporary series 1
• Specific studies report 0.5-3.1% 30-day mortality 2, 3
• Octogenarians: 3.1% perioperative mortality 3

Open Surgical Repair:

• Operative mortality: 4-5% 1
• Contemporary data shows 3.0% perioperative mortality in selected patients 2
• Young fit patients (<65 years): 1% 30-day mortality 4

The perioperative mortality advantage for EVAR is statistically significant (OR 0.36; 95% CI 0.2-0.66) but this benefit dissipates after 6 months 1. After 8 years, EVAR patients demonstrate higher aneurysm-related death (hazard ratio 5.12; 95% CI 1.6-16.4) 1.

Major Cardiac and Stroke Complications

Open Repair:

• Nearly one-third of patients experience major complications including cardiac and pulmonary events 1
• 5-10% rate of perioperative cardiovascular complications (death, MI, or stroke) 1
• Cardiorespiratory complications are more common and clinically significant than EVAR complications 4

EVAR:

• Lower perioperative cardiovascular morbidity compared to open repair 1
• 12% overall 30-day complication rate in young patients 4

Pulmonary Complications

Open Repair:

• Included in the approximately 33% major complication rate 1
• Mean mechanical ventilation duration: 5.0 hours 2

EVAR:

• Reduced mechanical ventilation: 3.6 hours mean duration 2

Wound Complications

Open Repair:

• Significant incisional hernia risk, particularly in obese patients 1
• Prophylactic mesh recommended in high-risk cases 1

EVAR:

• Minimal wound complications due to percutaneous femoral approach 1

Reintervention Rates

EVAR:

• 14-29.4% require secondary intervention during follow-up 5, 3
• Endoleak incidence: up to one-third of patients (25-29.4%) 1, 3
• Type I endoleaks: 6-7% 3
• Type II endoleaks: 15% 3
• Annual rupture rate with older-generation devices: 1% 1
• Conversion to open repair: 2% annually with older devices, 2.2% overall 1, 3
• Conversion-associated mortality: 24% 1
• Young patients (<65 years): 14% reintervention rate 4

Open Repair:

• 7% reintervention rate in young patients 4
• Lower long-term reintervention requirements compared to EVAR 1

Perioperative Metrics

EVAR advantages:

• Median procedure time: 2.9 hours vs 3.7 hours for open 2
• Blood loss: 200 mL vs 1000 mL for open 2
• Transfusion requirement: 0 units vs 1.0 unit for open 2
• Hospital stay: 3 days vs 7 days for open 2
• ICU stay: 1 day vs 4 days for open 2
• 54.3% of patients discharged on first postoperative day 3

Long-Term Survival

Overall Survival (EVAR):

• 2-year mortality: 7.0% 2
• 1-year freedom from all-cause mortality: 84.3% 3
• 5-year freedom from all-cause mortality: 27.4% in octogenarians 3
• 5-year freedom from aneurysm-related mortality: 92.9% 3

Overall Survival (Open Repair):

• 2-year mortality: 9.8% (not significantly different from EVAR) 2
• 5-year survival: approximately 60% for patients in their 70s 1
• Young patients with bicuspid valve/root-sparing procedures: >80-90% 10-year survival 1

Critical Caveat: The initial survival advantage of EVAR becomes equivalent to open repair after 6 months, and after 8 years EVAR demonstrates higher rates of aneurysm rupture (OR 5) and secondary interventions (hazard ratio 2.1; 95% CI 1.7-2.7) 1. This temporal pattern reflects the trade-off between lower perioperative risk and higher late complications with EVAR.

Quality of Life Outcomes

No significant differences in health-related quality of life or erectile function between EVAR and open repair at 2-year follow-up 2. However, open repair patients experience increased risk for impotence 1.

Cost Considerations

EVAR costs approximately 1 million yen more than open repair 5, though this must be balanced against shorter hospital stays and faster recovery.