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Madhukar S. Patel, ScM; David A. Brown, PhD; Samuel E. Wilson, MD

Arch Surg. 2009;144(9):806-810.

Hypothesis  Neither the ADAM nor the UK Small Aneurysm trials showed an advantage for early open surgical repair of abdominal aortic aneurysms (AAAs) smaller than 5.5 cm in diameter. The rigorous exclusion criteria of these studies, however, limited surgery to low-risk patients. We tested the hypothesis that endovascular aneurysm repair (EVAR) has been successfully used for higher-risk patients, thus questioning the utility of the ADAM and UK Small Aneurysm trials exclusion criteria in EVAR patient selection.

Design  Retrospective case review.

Setting  An urban Veterans Affairs Medical Center.

Patients  Forty-four consecutive cases of patients with AAA who received EVAR.

Main Outcome Measures  Electronic medical records were accessed for 11 high-risk conditions that would have excluded patients from the open surgery trials, and 30-day interventional morbidity and mortality data were collected.

Results  The mean (SD) age of patients who underwent EVAR was 73.2 (10.3) years, with a mean (SD) AAA diameter of 5.8 (1.6) cm. Of 44 patients, 19 (43%) met at least 1 exclusion criterion that would have prevented randomization in the small AAA trials. Significant perioperative complications occurred in 14 patients (32%) and 1 death occurred at home within 30 days of the procedure.

Conclusions  Patients receiving EVAR at an urban Veterans Affairs Medical Center had a greater prevalence of high-risk conditions than patients included in the ADAM and UK Small Aneurysm trials, and overall perioperative morbidity and mortality were lower. Endovascular aneurysm repair has extended aneurysm repair to a higher-risk population with greater safety.

Author Affiliations: Department of Surgery, University of California, Irvine Medical Center, Orange, and the Surgical Service, Veterans Administration Medical Center, Long Beach, California.

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