Abstract: Objective:To analyze and compare the clinical efficacies of endovascular aneurysm repair (EVAR) and open surgery repair (OSR) in patients with abdominal aortic aneurysm (AAA).
Methods:The clinical data of 271 patients with AAA who received surgery at the First Hospital of China Medical University between January 2004 and December 2014 were retrospectively analyzed. Of the 271 patients, 153 patients undergoing EVAR were allocated into the EVAR group and 118 patients undergoing OSR into the OSR group, respectively. All the patients underwent a primary screening of preoperative ultrasonography and were diagnosed by threedimensional computed tomography angiography (CTA), then urgent and severe patients were confirmed by abdominal enhanced CT. The procedures of EVAR: guide wire was inserted into the abdominal arota from femoral artery incision and branched stent was placed. The procedures of OSR: AAA was resected by median abdominal incision, thrombi and sclerosis plaques in endovascular wall were cleared, and endtoend abdominal aortic anastomosis and endtoside iliac  aortic anastomosis were performed using Yshaped blood vessel prosthesis. All the patients were followed up by telephone interview up to December 31, 2014. The operation situation, complications at postoperative day 30, shortterm complications (between postoperative 3 months and 3 years), medium and longterm complications (more than postoperative 3 years), mortality and survival rate were observed. Measurement data with normal distribution were presented as x±s and analyzed using the t test,  and count data were analyzed using the chisquare test or Fisher exact probability. Survival curve was drawn by the KaplanMeier method, and survival rate was analyzed using the Logrank test.
Results:All the patients were confirmed as with AAA by preoperative threedimensional CTA. The operation time, volume of intraoperative blood loss, volume of intraoperative blood transfusion, time for outoffbed activity, duration of hospital stay and hospital expenses were (179±64)minutes, (79±36)mL, 0, (5.7±3.1)days, (12±6)days, (179 018±65 796)yuan in the EVAR group and (205±40)minutes, (402±297)mL, (410±367)mL, (8.3±2.1)days, (18±11)days, (77 853±21 164)yuan in the OSR group, with significant differences between the 2 groups (t=-32.464, -51.719,-294.350,-11.833,-10.957, 2 778.748, P<0.05). The number of patients complicated with postoperative hypoxemia, myocardial ischemia, arrhythmia, diarrhea, penial and scrotal oppressive edema, ureteral calculus, acute urinary retention, thrombosis, infection, retroperitoneal hematoma, unhealed incision, death from multiple organ dysfunction syndrome (MODS) and death from severe cardiac insufficiency were 0, 0, 2, 5, 0, 0, 2, 2, 11, 0, 2, 0 and 2 in the EVAR group and 2, 2, 3, 10, 1, 2, 0, 3, 11, 2, 0, 1 and 1 in the OSR group, with no significant difference between the 2 groups (P>0.05).  The number of patients complicated with postoperative heart failure and Ishaped inner leakage were 0 and 8 in the EVAR group and 4 and 0 in the OSR group, with a significant difference between the 2 groups (P<0.05). Of the 271 patients, 229 were followed up for 1-132 months and 42 lost to followup (29 in the EVAR group and 13 in the OSR group). The results of postoperative shortterm followup: the number of patients complicated with pneumonia, intestinal obstruction, cerebral thrombus,  thrombosis of lower extremities, postactivity lower extremities pain, lower extremities paresthesia, perineal paresthesia, infection, Ishaped inner leakage, bending and stripped stents, anastomotic aneurism, death from MODS and intermittent diarrhea were 0, 0, 0, 2, 8, 11, 1, 2, 2, 1, 0, 2 and 0 in the EVAR group and 2, 1, 2, 4, 2, 7, 1, 2, 0, 0, 2, 1 and 3 in the OSR group, with no significant difference between the 2 groups (P>0.05). The number of patients complicated with chest pain and abdominal distension were 0 and 0 in the EVAR group and 4 and 4 in the OSR group, with a significant difference between the 2 groups (P<0.05). The results of postoperative medium and long term followup: the number of patients complicated with infection, stripped stents, death from MODS, postactivity lower extremities pain, death from infectious shock, death from ruptured aneurysm and death from heart disease were 0, 1, 1, 3, 2, 1 and 2 in the EVAR group and 2, 0, 0, 1, 2, 0 and 0 in the OSR group, with no significant difference between the 2 groups (P>0.05). The 3, 5, 10year survival rates in the EVAR group and in the OSR group were 94.35%, 89.52%, 60.48% and 93.33%, 91.42%, 69.52%, respectively, showing no significant difference between the 2 groups (χ²=0.103, 0.239, 2.033, P>0.05).
Conclusion:EVAR has an advantage of microinvasion in perioperative management, and both of EVAR and OSR are effective for the treatment of AAA with equivalent incidence of complications and longterm survival rate.