Outcomes and Costs of Abdominal Aortic Aneurysm Reconstructive Therapy without the Possibility of Emergency Endovascular Treatment: a Double-center Observational Study

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Abstract Introduction Abdominal aortic aneurysm (AAA)-associated mortality has remained high in Romania over the past decade. The aim of this study was to evaluate whether the recent introduction of endovascular aneurysm repair (EVAR) has contributed to a decrease in AAA-related mortality in northwestern and central Romania and to identify the main determinants of procedure-related costs. Methods We conducted a double-center observational study comparing outcomes and costs in a prospective EVAR arm and a retrospective open surgical reconstruction (OSR) arm. Results A total of 117 patients were included (48.7% treated with EVAR; 39.3% presented with ruptured AAAs). OSR was associated with significantly higher post-intervention morbidity (greater number of complications, p < 0.01; longer intensive care unit stay, p < 0.001) and higher in-hospital mortality (p = 0.03). Overall mortality was similar to that reported in Romania before the widespread adoption of EVAR (25.6% vs. 20.3%, p = 0.36). EVAR-related average costs were significantly higher than those associated with OSR, at €13,734 (range: €10,016–€40,363) vs. €5,989 (range: €690–€68,205) (p < 0.001). Conclusions The selective introduction of EVAR for elective cases was not associated with a decrease in AAA-related mortality. EVAR remains more expensive than OSR in Romania. These findings suggest that reorganizing AAA management, particularly in emergency settings, might be an important objective in the northwestern and central regions of Romania.

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