Endovascular versus open surgical repair of abdominal aortic aneurysm with concomitant malignancy
Received 17 May 2006; accepted 16 September 2006.
Background
The management of patients with abdominal aortic aneurysm (AAA) and concurrent malignancy is controversial. This study retrospectively assessed the outcome of endovascular repair (EVAR) and open repair (OR) for the treatment of AAA in patients undergoing curative treatment for concomitant malignancies.
Methods
All patients who underwent surgery for a nonruptured infrarenal AAA of ≥5.5 cm and concomitant malignancy between 1997 and 2005 were retrospectively reviewed.
Results
Identified were 25 patients (22 men; mean age, 70.3 years) with nonruptured infrarenal AAA of ≥5.5 cm (mean size, 6.4 cm) and concomitant malignancy amenable for curative treatment. EVAR was used to treat 11 patients, and 14 underwent OR. The EVAR patients had a smaller mean aneurysm size (5.9 cm vs 6.8 cm; P = .006) than the OR patients. The mean cumulative length of stay for all patients who received treatment for both AAA and cancer was 12.8 days (range, 4 to 26) for EVAR and 18.2 days (range, 9 to 42 days) for OR. In the EVAR group, no patients died perioperatively; in the OR group, three patients died perioperatively (21.4%; P = NS). Postoperative complications occurred in one patient in the EVAR group and in seven in the OR group for a morbidity rate, respectively, of 9.1% and 50% (P = .04). One late complication (9.1%) occurred in the EVAR group. The mean follow-up was 37.7 months (range, 16 to 60 months) in the EVAR group and 29.6 months (range, 11 to 55 months) in the OR group. At 1 and 2 years, survival rates were 100% and 90.9% in the EVAR group and 71.4% and 49% in the OR group (log-rank P = .103)
Conclusions
With low morbidity and mortality, EVAR is a safe technique for the treatment of AAA in patients with concomitant malignancy and could be considered as an alternative to OR.
aDepartment of General and Vascular Surgery, Federico II University, Naples, Italy
bDepartment of Surgery, Whipps Cross University Hospital, London, United Kingdom.
Reprint requests: Massimo Porcellini, MD, Department of General and Vascular Surgery, Federico II University, via Pansini 5, 80131 Naples, Italy.
ABSTRACT