The Repair of Abdominal Aortic Aneurysm with Ischemic Heart Disease: EVAR vs Open AAA Repair

Purpose: The analyses of preoperative factors and surgical outcomes influencing patients with IHD following endovascular aneurysm repair (EVAR) and open AAA repair (OAR) were performed comparatively.
Methods: From 2012 to 2016, 77 consecutive patients with IHD underwent scheduled operation for AAA in our hospital. Patients diagnosed AAA of more than 5cm in diameter and IHD with an indication of coronary artery revascularization underwent simultaneous CABG and OAR, or EVAR and staged PCI. Patients with AAA of less than 5cm in diameter underwent primary PCI or CABG, and staged EVAR or OAR. 47 patients underwent EVAR, and 30 patients underwent OAR.
Result: In the preoperative factors, the EVAR group was significant older than the OAR group: 74.8 +/- 7.4 years and 68.9 +/- 5.3 years (p = 0.001). LVEF, number of coronal lesion, e-GFR and diameter of AAA were not significant difference between the both groups. There were two hospital death (1: EVAR group and 1: OAR group). In the long term follow up at 50 months after the operation, freedoms from cardiac events were 86.8 +/- 4.0% and 90.8 +/- 5.2% (p = 0.922), freedoms from vascular event were 78.7 +/- 5.9% and 85.5 +/- 6.1% (p = 0.717) and survival rates were 95.4 +/- 2.6% and 87.3 +/- 6.5% (p = 0.481).
Conclusion: Although the EVAR group was older than the OAR group significantly, the long term results were not significant difference between the both groups. Our strategy of AAA with IHD was found to be satisfactory.