Has the emergence of endovascular treatment for aneurysmal and occlusive aortic disease increased the complexity and difficulty of open aortic operations?

With the emergence of endovascular surgery, there is a perception that open aortic procedures for aneurysmal and occlusive disease have become more difficult. To test this hypothesis, two consecutive groups of patients undergoing open aortic surgery for aneurysmal (AAA) and occlusive (AIOD) disease before and after the establishment of an endovascular program (EP) were analyzed. The pre-EP patient group (January 1996 through December 1997) consisted of 112 patients (52 with AAA, 60 with AIOD) and the post-EP patient group (January 2000 through December 2001) consisted of 142 patients (72 with AAA, 70 with AIOD). The pre-EP AAA group was compared with the post-EP AAA group and the pre-EP AIOD group was compared with the post-EP AIOD group. Factors analyzed included patient demographics, comorbidities, and operative outcomes. Statistical comparisons were carried out using Fisher's exact test for proportions and the Wilcoxon rank-sum test for medians. There were no statistical differences in patient demographics between the pre-EP and post-EP groups, regardless of procedure. When considering AAA repair, there was a higher rate of hypertension and hypercholesterolemia in the pre-EP group and a higher number of total comorbidities per patient in the post-EP group. There was also an increased incidence of perioperative blood transfusion in the post-EP group. When considering open procedures for AIOD, there was an increased rate of hypertension and history of previous abdominal operation in the post-EP group. There also was an increased incidence of perioperative blood transfusion. Other than these factors, there were no statistically significant differences between the pre- and post-EP groups with regard to mortality, complication rate, length of procedure, blood loss, length of ICU stay, or length of hospital stay for either the aneurysmal patients or the occlusive disease patients. With only minor exception, endovascular surgery has not appreciably increased the complexity of open aortic operations performed for either AAA or AIOD.