Electieve endovasculaire of open behandeling van het infrarenale AAA?

Some 79% of elective abdominal aortic aneurysm (AAA) repairs in the Netherlands are done with an endovascular stent graft (EVAR) because of its lower risk of perioperative mortality and complications compared to open surgical repair. However, after 2-3 years the survival benefit of EVAR is lost whereas there is an increased risk of re-interventions. The late results of the OVER trial confirm the outcomes of previous RCTs. To improve the long-term outcomes of EVAR it is necessary to use stent grafts only in patients with suitable anatomy, comply with the diameter threshold for elective repair, and to evaluate the efficacy of surveillance to avoid unnecessary re-interventions. Open repair is still a valid surgical option, especially in patients with good life expectancy and suboptimal anatomy for EVAR. Weighing up the pros and cons of both surgical options is of paramount importance; furthermore, consideration of the patient’s preference facilitates proper shared decision making.

Conflict of interest and financial support: none declared.