Outcomes of endovascular treatment of infrarenal abdominal aortic aneurysms: A single centre experience
Keywords:
aortic aneurysm, minimally invasive surgery, postoperative recovery, surgical complications, blood loss, heart diseaseAbstract
Background and aim: This study aimed to compare the efficacy and safety of endovascular repair and open aortic repair (OAR) in the treatment of infrarenal abdominal aortic aneurysm (AAA) using data from the National Scientific Center of Surgery named after A.N. Syzganov.
Methods: A retrospective analysis was conducted on 105 patients treated between 2018 and 2023: 80 underwent endovascular repair and 25 received OAR.
Results: Endovascular repair was associated with shorter hospital stays (13 versus 18.6 days; p=0.001), shorter time in the intensive care unit (1.34 versus 2.28 days; p=0.024), shorter operation duration (180 versus 289 minutes; p=0.001), less time for aortic clamping, reduced blood loss, and fewer transfusion requirements. Although the endovascular repair group had higher rates of comorbidities (p<0.005), postoperative complications were similar between the groups (p≥0.005). In-hospital mortality occurred only in the endovascular repair group, while the five-year survival rate was slightly higher in the OAR group (80% versus 76.25%), though not statistically significant (p≥0.005). Despite the higher rate of comorbidities in the endovascular intervention group, the incidence of postoperative complications was comparable in both groups.
Conclusions: Both approaches have their advantages and limitations, and the choice of method should be based on individual patient characteristics and clinical situation. The practical significance of the study was to provide an evidence base for informed choice between endovascular and OAR in treating infrarenal AAA, and a personalized approach to surgical planning considering individual patient characteristics and risk factors.
References
1. Song P, He Y, Adeloye, D, et al. The global and regional prevalence of abdominal aortic aneurysms: A systematic review and modelling analysis. Ann Surg. 2023; 277(6):912-9. doi:10.1097/SLA.0000000000005716
2. Pop C, Bota SN. Giant thoracoabdominal aortic aneurysm after endovascular repair. J Clin Med Kaz. 2020;3(57):53-4. doi:10.23950/1812-2892-JCMK-00774
3. Chinaliyev AM, Jussubaliyev YI, Khassenov DT, et al. Complicated mycotic saccular aneurysm of the infra-renal abdominal aorta with infected retroperitoneal hematoma: A clinical case report. Front Cardiovasc Med. 2024;11:1497561. doi:10.3389/fcvm.2024.1497561
4. Zemlyanskiy VV, Zemlyanskaya NS, Sultanaliev TA, Dautov TB, Kozhakhmetov SK, Openko VG. Interventional methods for preventing complications after endovascular replacement of infrarenalc aortic aneurysms: A literature review. Sci Healthc. 2023;25(1):160-72. doi:10.34689/SH.2023.25.1.020
5. Canning P, Tawfick W, Whelan N, Hynes N, Sultan S. Cost-effectiveness analysis of endovascular versus open repair of abdominal aortic aneurysm in a high-volume centre. J Vasc Surg. 2019;70(2):485-96. doi:10.1016/j.jvs.2018.11.018
6. Mei H, Xu Y, Wang J, Ma S. Evaluation of survival outcomes of endovascular versus open aortic repair for abdominal aortic aneurysms with a big data approach. Entropy. 2020;22(12):1349. doi:10.3390/e22121349
7. Chung J. Epidemiology, risk factors, pathogenesis, and natural history of abdominal aortic aneurysm. 2025. https://www.uptodate.com/contents/epidemiology-risk-factors-pathogenesis-and-natural-history-of-abdominal-aortic-aneurysm
8. Jones DW, Deery SE, Schneider DB, et al. Differences in patient selection and outcomes based on abdominal aortic aneurysm diameter thresholds in the Vascular Quality Initiative. J Vasc Surg. 2019;70(5):1446-55. doi:10.1016/j.jvs.2019.02.053
9. Schmitz-Rixen T, Böckler D, Vogl TJ, Grundmann RT. Endovascular and open repair of abdominal aortic aneurysm. Germ Med J Int. 2020;117(48):813-9. doi:10.3238/arztebl.2020.0813
10. Loufopoulos G, Tasoudis P, Koudounas G, et al. Long-term outcomes of open versus endovascular treatment for abdominal aortic aneurysm: Systematic review and meta-analysis with reconstructed time-to-event data. J Endovasc Ther. 2023;32(4):946-56. doi:10.1177/15266028231204805
11. World Health Organization. ICD-10. International statistical classification of diseases and related health problems, 10th revision. Geneva: World Health Organization; 2019. https://icd.who.int/browse10/2019/en#/I71.4
12. Wanhainen A, Verzini F, Van Herzeele I, et al. European Society for Vascular Surgery (ESVS) 2019 clinical practice guidelines on the management of abdominal aorto-iliac artery aneurysms. Eur J Vasc Endovasc Surg. 2019;57(1):8-93. doi:10.1016/j.ejvs.2018.09.020
13. Hynes N, Acharya Y, Sultan S. The contemporary design of endovascular aneurysm stent-graft materials: PTFE versus polyester. Front Surg. 2022;9:984727. doi:10.3389/fsurg.2022.984727
14. Sfyroeras GS. Patient selection for endovascular AAA repair. In: Geroulakos G, Avgerinos E, Becquemin JP, Makris GC, Froio A, editors. Mastering Endovascular Techniques: Tips and Tricks in Endovascular Surgery. Cham: Springer; 2024. pp. 473-81. doi:10.1007/978-3-031-42735-0_44
15. Vaidyanathan AK. Basics in statistics: Sample size calculation and descriptive data statistics. J Indian Prosthodont Soc. 2023;23(3):207-9. doi:10.4103/jips.jips_307_23
16. Tsushima E. Interpreting results from statistical hypothesis testing: Understanding the appropriate P-value. Phys Ther Res. 2022;25(2):49-55. doi:10.1298/ptr.R0019
17. Rebasa Cladera P. Multivariate analysis in surgical studies. Span Surg. 2022;100(11):731-3. doi:10.1016/j.cireng.2022.03.017
18. Lapid MI, Clarke BL, Wright RS. Institutional Review Boards: What clinician researchers need to know. Mayo Clin Proc. 2019;94(3):515-5. doi:10.1016/j.mayocp.2019.01.020
19. Cattolico A, Sergio F, Boemio A, et al. Preliminary Anatomical and Surgical Assessment of Combined Percutaneous Resection and Proximal Medial Gastrocnemius Release vs Historical Controls in Treating Haglund syndrome: A Mixed Prospective-Retrospective Study. Foot Ankle Orthopaed. 2025;10(3):24730114251372601. doi:10.1177/24730114251372601
20. Yessentayeva SY, Orakbay LZ, Adilhanova A, Yessimov N. Approaches to the use of stem cells in regenerative medicine. Anal Biochem. 2022;645:114608. doi:10.1016/j.ab.2022.114608
21. Nikolaev E, Nikolov N, Kostov D, et al. Resection or enucleation for liver hemangioma. Surg Chron. 2021;26(1):25-9. https://www.researchgate.net/publication/356413012_Resection_Or_Enucleation_For_Liver_Hemangioma
22. Tkachuk OL, Dudyj PF, Tkacuk LO, Bielinskyi MV, Herashchenko AS, Parakhoniak RL. Optimization of the algorithm for selecting the fundoplication method in the surgical treatment of patients with hiatal hernia. Mod Gastroenterol. 2025;2025(3):12-8. doi:10.30978/MG-2025-3-12
23. Tutchenko MI, Rudyk DV, Klyuzko IV, Besedinskyi MS, Chub SL, Sirenko OA. Treatment of portal hypertension complicated by variceal bleeding. Emerg Med Ukr. 2024;20(3):180-5. doi:10.22141/2224-0586.20.3.2024.1690
24. Merkhatuly N, Iskanderov AN, Zhokizhanova SK, Kezdikbaeva AT, Ibraeva AK. Stereoselective Synthesis of cis-Eudesmane Esters Based on (–)-α-Santonin. Chem Nat Comp. 2017;53(3):582-3. doi:10.1007/s10600-017-2057-5
25. Cattolico A, Sergio F, Catani O, et al. Correction of hallux valgus through minimally invasive percutaneous techniques: the WOS procedure Long-term efficacy and application across different age groups. Minerva Orthop. 2024;75(4):263-8. doi:10.23736/S2784-8469.24.04443-2
26. Turdybekov KM, Gafurov NM, Adekenov SM, Struchkov YT. Photochemical Transformation of Hanphilline and Crystal Structure of 1(10)Z,4Z-Hanphilline. Mendeleev Commun. 1994;4(3):81-2. doi:10.1070/MC1994v004n03ABEH000356
27. Tulewicz-Marti EM, Lewandowski K, Szczubelek M, Rydzewska G. Management of anaemia in patients with inflammatory bowel disease - results of a questionnaire among Polish healthcare professionals. Przegl Gastroenterol. 2021;16(1):89-94. doi:10.5114/pg.2021.104738
28. Nikolaev E, Nikolov N, Kostov D, et al. Pringle maneuver and blood loss in the surgical treatment of liver hemangioma (LH). Surg Chron. 2021;26(2):191-5. https://escientificlibrary.com/surgery/Article/ESJS-V1-1010.pdf
29. De Freitas S, D’Ambrosio N, Fatima J. Infrarenal abdominal aortic aneurysm. Surg Clin North Am. 2023;103(4):595-614. doi:10.1016/j.suc.2023.05.001
30. Tramontin C, Affronti A, Cirio EM. Diagnostic and surgical management of HeartMate 3 outflow graft obstruction due to two different mechanisms. Asian Cardiovasc Thor Ann. 2022;30(7):826-9. doi:10.1177/02184923221106765
31. Tutchenko MI, Rudyk DV, Besedinskyi MS. Decompensated portal hypertension complicated by bleeding. Emerg Med Ukr. 2024;20(1):13-8. doi:10.22141/2224-0586.20.1.2024.1653
32. Anduaga I, Affronti A, Cepas-Guillén P, et al. Non-Pharmacological Stroke Prevention in Atrial Fibrillation. J Clin Med. 2023;12(17):5524. doi:10.3390/jcm12175524
33. Banchev A, Stoyanova D, Konstantinov D, et al. Beyond the bleeding rates- HEAD-US joint assessment in patients treated by late prophylaxis. Haemophilia 2019;25(4):e294-e297. doi:10.1111/hae.13771
34. Yessimov N, Izmailova N, Yessimov D. Integration of primary healthcare and public health. Int J Electron Healthcare. 2021;11(4):289-306. doi:10.1504/IJEH.2021.117826
35. Gancho OV, Bublii TD, Kostyrenko OP, Fedorchenko VI. Antimicrobial effect of citrate buffer with antibiotic. East Ukr Med J. 2022;10(1):80-7. doi:10.21272/eumj.2022:10(1):80-87
36. Aggarwal S, Qamar A, Sharma V, Sharma A. Abdominal aortic aneurysm: A comprehensive review. Exp Clin Cardiol. 2011;16(1):11-5. PMID: 21523201
37. Björck M. Endovascular or open repair for ruptured abdominal aortic aneurysm? Br Med J. 2017;359:j5170. doi:10.1136/bmj.j5170
38. Owens DK, Davidson KW, Krist AH, et al. Screening for Abdominal aortic aneurysm: US preventive services task force recommendation statement. JAMA. 2019;322(22):2211-8. doi:10.1001/jama.2019.18928
39. Kimura Y, Ohtsu H, Yonemoto N, Azuma N, Sase K. Endovascular versus open repair in patients with abdominal aortic aneurysm: A claims-based data analysis in Japan. BMJ Surg Intervent Health Technol. 2022;4(1):e000131. doi:10.1136/bmjsit-2022-000131
40. Gibello L, Verzini F, Spalla F, et al. Long-term outcomes of open and endovascular abdominal aortic repair in younger patients. Ann Vasc Surg. 2022;85:323-30. doi:10.1016/j.avsg.2022.02.021
41. Mascoli C, Faggioli G, Goretti M, et al. Endovascular treatment of abdominal aortic aneurysm with severe angulation of infrarenal aortic neck by gore conformable endograft. J Endovasc Ther. 2023;30(3):410-8. doi:10.1177/15266028221083461
42. Qayyum H, Hansrani V, Antoniou GA. Prognostic role of severe infrarenal aortic neck angulation in endovascular aneurysm repair. Eur J Vasc Endovasc Surg. 2021;62(3):409-21. doi:10.1016/j.ejvs.2021.05.014
43. Raju S, Eisenberg N, Montbriand J, Roche-Nagle G. Endovascular repair of abdominal aortic aneurysm in octogenarians: Clinical outcomes and complications. Can J Surg. 2020;63(4):e329-e337. doi:10.1503/cjs.009019
44. Marcos Garcia L, Calsina Juscafresa L, Velescu A, et al. Outcome of elective endovascular repair of abdominal aortic aneurysms in octogenarians. Geriatr Gerontol Int. 2021;21(5):392-7. doi:10.1111/ggi.14148
45. Lin R, He HP, Zhao Y, Lv JB, Peng JX, Yin HH. Outcomes following different management of mycotic infrarenal abdominal aortic aneurysms. J Endovasc Ther. 2024;33(1):285-94. doi:10.1177/15266028241253128
46. Veličković VM, Carradice D, Boyle JR, et al. Umbrella review and meta-analysis of reconstructed individual patient data of mortality following conventional endovascular and open surgical repair of infrarenal abdominal aortic aneurysm. Exp Rev Cardiovasc Ther, 2023;21(5):347-56. doi:10.1080/14779072.2023.2207009
47. Powell JT, Sweeting MJ, Thompson MM, et al. Endovascular or open repair strategy for ruptured abdominal aortic aneurysm: 30 day outcomes from IMPROVE randomised trial. BMJ. 2014;348:f7661. doi:10.1136/bmj.f7661
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Adil Baimbetov, Ingkar Omarkyzy, Almas Saduakas, Erzhan Abilkhanov, Aiman Jukenova
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Transfer of Copyright and Permission to Reproduce Parts of Published Papers.
Authors retain the copyright for their published work. No formal permission will be required to reproduce parts (tables or illustrations) of published papers, provided the source is quoted appropriately and reproduction has no commercial intent. Reproductions with commercial intent will require written permission and payment of royalties.
How to Cite
