AB038. SOH22ABS133. Swings and roundabouts—is open abdominal aortic aneurysm surgery back in fashion?

Background: Endovascular aortic aneurysm repair (EVAR) has become increasingly popular in the past two decades, accounting for at least 60% of all abdominal aortic aneurysms (AAA) repairs in Europe and up to 85% in the USA. It has been the preferred option for many patients as it is minimally invasive, cost-effective and often suitable for patients deemed unfit for open repair. However, 30–50% of patients who have EVAR do not fulfil instructions for use (IFU). Depending on their life expectancy, they may be better treated with operating room (OR). Long term follow-up of OR procedures demonstrate better durability compared to EVAR.

Methods: All patients who underwent AAA surgery between 2006 and 2021 in St. Vincent’s University Hospital were included in this study. Data was collated from a prospective database cross-referenced with electronic theatre logbooks and HIPE data.

Results: A total of 640 AAA repairs were performed: 529 were elective (82.7%) and 111 emergency (17.3%) repairs. Of the elective repairs 261 (49.3%) were performed by EVAR and 51% by OR. The percentage of EVAR annually has increased from 22% in the earlier part of the series to 70% in 2013 with a decline towards 50% in the past five years.

Conclusions: Despite international trends towards EVAR as the most commonly performed technique for AAA repair our centre has maintained a large experience of OR surgery over the past 15 years. Preservation of OR volume increases durability of repair and, in addition, may offer a solution to the challenge of OR training.

Keywords: Abdominal aortic aneurysms (AAA); aortic surgery; endovascular repair; surgical training; vascular trainees