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Reintervention Following EVAR and Open Surgical Repair of AAA: A 15-year Experience
Mustafa Al-Jubouri*, Subhash Thakur*, Faisal Aziz*, Anthony J Comerota
Jobst Vascular Institute, Toledo, OH

Objectives: EVAR has largely replaced open surgical repair (OSR) for anatomically appropriate AAA because of improved short-term outcomes. However, EVAR is associated with a notable reintervention rate. This study examined the outcomes of EVAR and OSR to compare the frequency and reason for reintervention.
Methods: Data for patients undergoing elective AAA repair between 1996 and 2011 were collected and analyzed to assess time from initial procedure to reintervention and rate of reintervention.
Results: 1144 patients underwent AAA repair; 558 (49%) had EVAR and 586 (51%) had OSR. Reinterventions occurred in 76 EVAR and 30 OSR patients (13.6% vs 5.1%, P< 0.0001). Endoleak was responsible for 66% of EVAR reinterventions; bleeding and incisional hernia repair were responsible for 22% each of OSR reinterventions. Time to first reintervention was shorter in OSR patients (P<0.001) and was related to AAA size (P<0.001). 50% and 77% of OSR reinterventions occurred within 1 month and 1 year of initial repair, respectively. 6.5% of EVAR reinterventions occurred within 1 month and 34% within 1 year. Reintervention after OSR has not changed over time, whereas it is decreasing after EVAR (Table).
Conclusion: Reintervention was more common with EVAR and occurred later compared with OSR, indicating that long-term follow-up remains necessary. Reintervention rates following EVAR appear to be decreasing.
YearsEVAR GroupOSR Group
NReintervention N (%)NReintervention N (%)
1996-1999319 (29.0)2068 (3.8)
2000-200213121 (16.0)14910 (6.7)
2003-200510917 (15.6)795 (6.3)
2006-200815024 (16.0)794 (5.0)
2009-20111375 (3.6)733 (4.1)


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