Elective Abdominal Aortic Aneurysm (AAA) repair: challenges remain

Abstract

This thesis evaluated the efficacy of elective abdominal aortic aneurysm repair. The first part of this thesis evaluated the presumed long-term survival differences of endovascular aneurysm repair (EVAR) versus open repair. Thereby, it evaluated the impact of developments in AAA management (i.e. the introduction of EVAR and cardiovascular risk management) on the long-term life-expectancy after repair. The second part of this thesis focused on other outcomes important in the evaluation of AAA care. It evaluated the presumed long-term cost difference of EVAR and open repair. In addition, it investigated how the patient perspective is currently embedded in AAA research.

The five main conclusions of this thesis are that I) long-term (relative) survival between open versus endovascular aneurysm repair is equal; II) AAA patients remain a persistently high long-term (10-year) excess mortality after elective repair, with no change in mortality rates over the past 25 years; III) women have a notably higher short-and long-term mortality; IV) endovascular and open repair are considered cost equivalent; V) and the evaluation of the patient perspective/quality of life of AAA patients needs improvement.