Cardiovascular risk associated with EVAR and open repair of non-ruptured abdominal aortic aneurysms

Cardiovascular complications have a significant impact on the outcome of patients with an abdominal aortic aneurysm (AAA) treated by open repair (OR) or by endovascular aneurysm repair (EVAR). EVAR might be associated with fewer cardiovascular complications. This review was undertaken to analyze whether the selection of EVAR and OR has an effect on cardiovascular complications within randomized trials with intact AAA patients. Analysis of cardiovascular complications reported in the prospective, randomised trials (RCTs) comparing EVAR and OR in the elective treatment of intact AAAs. Four RCTs give evidence that EVAR is associated with a significantly lower perioperative mortality rate. Cardiovascular mortality and complication rates do not differ significantly between the two treatment options; this is also true for the long-term follow-up. Cardiac complications are inconsistently reported and vary widely. These results are true for patients with a low or average surgical risk and an AAA which can be treated by OR and EVAR. Large registries indicate that especially for high-risk patients and patients > 80 years the cardiovascular event rate is significantly reduced by the use of EVAR rather than OR. EVAR is associated with a significantly lower perioperative mortality rate. Patients with a normal or average surgical risk have similar cardiovascular outcomes. Elderly patients and high-risk patients may benefit from EVAR.