Comparison of open surgery and endovascular treatment of asymptomatic juxta/pararenal abdominal aortic aneurysm
Abstract
Endovascular abdominal aortic aneurysm repair (EVAR) has gained widespread acceptance in the treatment of patients with abdominal aortic aneurysm (AAA). The applicability of EVAR is limited by the absence of adequate infrarenal neck or involvement of the visceral arteries, such as in juxtarenal and pararenal AAA (JAAA/PAAA). Current guidelines recommend that elective management of JAAA/PAAA and the choice of different techniques and different options should be considered based on patient status, anatomy, local routines, team expertise, and patient preference. The main advantage endovascular techniques lies in the avoidance of aortic cross clamping and subsequent lower risk of renal dysfunction, less surgical trauma and faster recovery, which may be advantageous for patients at high risk of open surgery. However, recent reports show that JAAA/PAAA patients can be treated in high-volume aortic centres with low short-term mortality and morbidity and good medium- and long-term results that are equal in both groups. Low-surgical-risk patients might benefit from open surgery, while high-risk patients might benefit from endovascular first approach of JAAA/PAAA. This provides useful information to help clinicians and patients choose between the two procedures when both are available.
References
1. Powell JT, Sweeting MJ, Ulug P, Blankensteijn JD, Lederle FA, Becquemin J-P, et al. Meta-analysis of individual-patient data from EVAR-1, DREAM, OVER and ACE trials comparing outcomes of endovascular or open repair for abdominal aortic aneurysm over 5 years. Br J Surg. 2017;104:166–178.
2. Wanhainen A, Verzini F, Van Herzeele I, Allaire E, Bown M, Cohnert T., et al. Editor's Choice - 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, 8–93.
3. Chaikof EL, Dalman RL, Eskandari MK, Jackson BM, Lee WA, Mansour MA, et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J. Vasc. Surg. 2018, 67, 2–77.
4. Oderich GS, Forbes TL, Chaer R, Davies MG, Lindsay TF, Mastracci T, et al. Reporting standards for endovascular aortic repair of aneurysms involving the renal-mesenteric arteries. J. Vasc. Surg. 2020;73, 4-52.
5. Kabbani LS, West CA, Viau D, Nypaver TJ, Weaver MR, Barth C, et al. Survival after repair of pararenal and paravisceral abdominal aortic aneurysms. J Vasc Surg 2014;59:1488-94.
6. Ferrante AM, Moscato U, Colacchio EC, Snider F. Results after elective open repair of pararenal abdominal aorticv aneurysms. J Vasc Surg 2016;63:1443-50.
7. Pitoulias GA, Fazzini S, Donas KP, Salvatore T Scali, Mario D'Oria, Giovanni Torsello et al. Multicenter mid-term outcomes of the chimney technique in the elective treatment of degenerative pararenal aortic aneurysms. J Endovasc Ther. 2022;29:226–239.
8. Oderich GS, Farber MA, Schneider D et al. Zenith fenestrated study investigators. Final 5-year results of the United States Zenith Fenestrated prospective multicenter study for juxtarenal abdominal aortic aneurysms. J Vasc Surg 2021;73:1128–1138.
9. Wahlgren CM, Piano G, Desai T, Shaalan, Bassiouny. Transperitoneal versus retroperitoneal suprarenal cross-clamping for repair of abdominal aortic aneurysm with a hostile infrarenal aortic neck. Ann Vasc Surg 2007;21:687-94.
10. Taneva GT, Criado F, Torsello G, Veith F, Scali ST, Kubilis, et al. PERICLES collaborators. Results of chimney endovascular aneurysm repair as used in the PERICLES Registry to treat patients with suprarenal aortic pathologies. J Vasc Surg 2020; 71(5):1521-27.
11. Donas KP, Criado, F, Torsello G, Veith FJ, Minion, Lachatet al. PERICLES Registry Collaborators. Classification of Chimney EVAR-Related Endoleaks: Insights From the PERICLES Registry. J Endovasc Ther 2017; 24(1):72-74.
12. Zlatanovic P, Jovanovic A, Tripodi P, Davidovic L. Chimney Versus Fenestrated Endovascular Versus Open Repair for Juxta/Pararenal Abdominal Aortic Aneurysms: Systematic Review and Network Meta-analysis of the Short-term Results. World J Surg. 2023;47:803-823.
13. Katsargyris A, Oikonomou K, Klonaris C, Töpel I, Verhoeven EL. Comparison of outcomes with open, fenestrated, and chimney graft repair of juxtarenal aneurysms: are we ready for a paradigm shift? J Endovasc Ther. 2013;20:159-69.
14. Zlatanovic P, Jovanovic A, Tripodi P, Davidovic L. Chimney vs. Fenestrated Endovascular vs. Open Repair for Juxta/Pararenal Abdominal Aortic Aneurysms: Systematic Review and Network Meta-Analysis of the Medium-Term Results. J Clin Med. 2022;11:6779.
15. Zlatanovic P, Mascia D, Ancetti S, Yeung KK, Graumans MJ, Jongkind V, Viitala H, Venermo M; JAMES study group. Short Term and Long Term Clinical Outcomes of Endovascular versus Open Repair for Juxtarenal and Pararenal Abdominal Aortic Aneurysms Using Propensity Score Matching: Results from Juxta- and pararenal aortic Aneurysm Multicentre European Study (JAMES). Eur J Vasc Endovasc Surg. 2023 Feb 27:S1078-5884(23)00194-6.
16. Michel M, Becquemin JP, Clément MC, Marzelle J, Quelen C, Durand-Zaleski I; WINDOW Trial Participants. Editor's choice - thirty day outcomes and costs of fenestrated and branched stent grafts versus open repair for complex aortic aneurysms. Eur J Vasc Endovasc Surg. 2015;50:189-96.
17. Michel M, Becquemin JP, Marzelle J, Quelen C, Durand-Zaleski I. Editor’s Choice e A study of the cost-effectiveness of fenestrated/ branched EVAR compared with open surgery for patients with complex aortic aneurysms at 2 years. Eur. J. Vasc Endovasc. Surg 2018;56,15–428.
18. O'Donnell TFX, Boitano LT, Deery SE, Lancaster RT, Siracuse JJ, Schermerhorn ML, et al. Hospital Volume Matters: The Volume-Outcome Relationship in Open Juxtarenal AAA Repair. Ann Surg. 2020;271:184-190.
19. von Meijenfeldt GCI, Alberga AJ, Balm R, Vahl AC, Verhagen HJM, Blankensteijn JD, et al. Results from a nationwide prospective registry on open surgical or endovascular repair of juxtarenal abdominal aortic aneurysms. J Vasc Surg. 2022;75:81-89.
20. Končar IB, Jovanović AL, Dučič SM. The role of fEVAR, chEVAR and open repair in treatment of juxtarenal aneurysms: a systematic review. J Cardiovasc Surg (Torino). 2020;61(1):24-36.
21. Scali ST, Beck A, Sedrakyan A, Mao J, Behrendt CA, Boyle JR, et al. Editor's Choice - Optimal Threshold for the Volume-Outcome Relationship After Open AAA Repair in the Endovascular Era: Analysis of the International Consortium of Vascular Registries. Eur J Vasc Endovasc Surg. 2021;61:747-755.