Abdominal aortic aneursym: Stent graft vs clinical pathway for direct retroperitoneal repair

Background: Endovascular repair (EVAR), while not reducing mortality, has the advantages of reduced morbidity, shorter hospitalization, and quicker recovery when compared with open repair. These advantages must be balanced against increased cost, the risk of early- and late-onset endoleak, and the occasional need for secondary intervention or conversion to open repair. While continuing to offer EVAR, we have also developed a clinical pathway for open repair, which includes a retroperitoneal (RP) approach, nonroutine intensive care unit stay, no nasogastric tube, oral feedings beginning on the first postoperative day, and a hospital discharge between 3 and 5 days postoperatively. Hypothesis: Direct repair using the RP approach and a clinical pathway is competitive with EVAR. Method: Retrospective review of all RP and EVAR abdominal aortic aneursym procedures performed between January 2001 and December 2002. Results: Eighty-nine RP and 61 EVAR abdominal aortic aneursym repairs were performed. There were no deaths in either group. Conclusion: Results suggest that a clinical pathway including an RP approach resulted in a safe, effective, and rapid hospital discharge in most patients. While EVAR continues to yield a shorter hospital stay and fewer complications when compared with open repair, these benefits may be offset by the need for costly continual computed tomographic scan surveillance, the occasional need for late intervention or conversion to open repair, and the small but finite risk of late rupture.