Endovascular abdominal aortic aneurysm repair versus open surgery

Abdominal aortic aneurysm (AAA), an abnormal localized dilatation of the abdominal aorta, occurs in 5% of men and 1% of women over the age of 65 years, and the rupture of an AAA is a significant cause of death. Repair of AAA in an elective setting by a conventional open surgical approach has reasonable long-term survival, but it carries a high risk to older patients or those with comorbidities such as cardiovascular or pulmonary conditions. In contrast to open surgery, endovascular AAA repair (EVAR) is a catheter-based procedure that does not require an abdominal incision or dissection and clamping of the aorta. In Canada, between April 2004 and March 2009, close to 16,000 AAA procedures were performed, with elective EVAR procedures increasing from 11.5% in 2005 to 35.5% in 2009. This review is an update of a previous Rapid response review on the same topic in 2009, and aims to compare the clinical and cost-effectiveness of elective EVAR with open surgery repair.