Infrarenal and juxtarenal abdominal aortic aneurysm repair in young patients.

Abstract

To report the outcome of elective open surgical repair (OSR) and endovascular repair (EVAR) of primary infrarenal (IR) and juxtarenal (JR) abdominal aortic aneurysms (AAA) in patients <70 years of age. Single-center retrospective study of consecutive patients <70 years old with primary IRAAA and JRAAA treated by OSR and EVAR between January 2010 and December 2021. The primary end point was 30-day mortality. Secondary end points were survival and freedom from reintervention. Data are presented as median (interquartile range [IQR]). A P value of <.05 was considered significant. We included 230 patients (214 men; median age 65 years; range, 64-67 years) who underwent repair of IRAAA (n = 133; 53 OSR, 80 EVAR) and JRAAA (n = 97; 30 OSR, 67 fenestrated EVAR). Coronary artery disease was more prevalent in EVAR patients (48% vs OSR, 23%; P < .001) and those with JRAAA (51% vs IRAAA: 31%; P = .003). The 30-day mortality rate was 0.9% (n = 2). Major nonfatal complications occurred in 2.4% of patients (2/83) after OSR and 3.4% (5/147) after EVAR: myocardial infarction (n = 1; OSR), temporary renal replacement therapy (n = 1; OSR), respiratory failure requiring prolonged ventilation (n = 2; EVAR), and reoperation (n = 5; OSR 2 vs EVAR 3). The median critical care and total hospital stay was as follows: OSR 2 days (IQR, 1-2 days) and 6 days (IQR, 4-7 days); EVAR 1 day (IQR, 0-1 day) and 2 days (IQR, 1-3 days) (P < .001). The median follow-up was 90 months (IQR, 59-121 months). Estimated 5-year survival (± standard error) and freedom from late reintervention were 89% ± 2% and 88% ± 2%, respectively, with no difference related to modality of repair (P = .53) or aneurysm extent (P = .25). IR EVAR, fenestrated EVAR, and OSR are associated with excellent early and mid-term outcomes in appropriately selected younger patients with IR and JR AAA.