Endovascular Aneurysm Repair (EVAR) vs. Open Repair: Long-Term Survival Outcomes

An abdominal aortic aneurysm is a dangerous enlargement of the main artery in the abdomen. If it ruptures, it can cause life-threatening bleeding. Two major treatments exist: Endovascular Aneurysm Repair (EVAR) and open surgical repair. EVAR is a minimally invasive procedure that uses a stent graft placed inside the aneurysm through blood vessels, while open repair involves a larger cut and direct surgical replacement of the damaged aorta. Although EVAR offers faster recovery, studies show differences in long-term survival. 

Short-term, EVAR has clear advantages. Patients usually experience shorter hospitalizations, lower early mortality, and fewer immediate complications due to the low degree of invasiveness (Howard et al., 2015). Many patients, especially older or high-risk individuals, benefit from the quicker recovery and reduced surgical stress. 

However, looking long-term, the trend increases in complexity. While EVAR allows for better survival within the first few months after surgery, studies show its early benefit decreases as the time period exceeds a couple months. Several long-term follow-up trials have shown that after 3-5 years, the survival rates of EVAR and open surgery become similar, and in some cases, open repair shows better outcomes beyond that period (Lederle et al., 2019).

One reason for this decline is the need for lifelong monitoring after EVAR. The implanted stent graft can shift, leak, or fail over time, requiring more imaging tests and sometimes repeated procedures (Fairman & Veeraswamy, 2020). These late complications can increase long-term mortality. In contrast, open repair usually has higher early risk but is more durable in the long-run, with fewer late complications once patients recover. Large clinical trials like the EVAR-1, EVAR-2, and DREAM studies have consistently shown similar patterns: EVAR provides early survival benefits but open repair often leads to more stable long-term results (Greenhalgh et al., 2016). Because of this, the choice between EVAR and open repair depends on patient age, anatomy, medical risk, and life expectancy.

In summary, EVAR offers better short-term outcomes and faster recovery, but open repair may provide better long-term durability with fewer late complications. Understanding these differences help doctors and patients choose the best treatment for each individual’s specific needs.

by Saket Parayil at Incisionary

APA References

Fairman, R. M., & Veeraswamy, R. K. (2020). Long-term considerations after endovascular aneurysm repair. Journal of Vascular Surgery, 72(4), 1334–1342.

Greenhalgh, R. M., Brown, L. C., & Powell, J. T. (2016). Endovascular versus open repair of abdominal aortic aneurysm: Long-term results of randomized trials. New England Journal of Medicine, 362(20), 1863–1871.

Howard, D. P. J., Wolstenholme, J. L., & Thompson, M. M. (2015). Early outcomes after EVAR versus open repair of AAA. British Journal of Surgery, 102(11), 1388–1397.

Lederle, F. A., Kyriakides, T. C., & Stroupe, K. T. (2019). Survival after open or endovascular repair of abdominal aortic aneurysm. JAMA, 322(14), 1383–1392.