Endovascular or open aortic aneurysm repair: which method is preferred?
Choosing the method is one of the most important decisions for a patient with an aneurysm. It depends on the anatomy, the age, the general condition and the experience of the centre.
Theodosios Bisdas, Associate Professor of Vascular Surgery and Director of the 3rd Vascular Surgery Department of the Athens Medical Center, specialises in endovascular as well as open and hybrid repair of aortic aneurysms, in the hybrid operating room of the Athens Medical Center.
What is open aneurysm repair
In open surgery the surgeon reaches the aorta through an incision in the abdomen or the chest. The aneurysmal segment is removed and replaced with a synthetic graft.
What is endovascular repair (EVAR / TEVAR)
In endovascular repair, an endograft (stent-graft) is advanced into the aorta through small punctures in the femoral arteries, under imaging guidance, and is deployed inside the aneurysm, excluding it from the circulation. No large incision is required and recovery is considerably faster. Modern branched and fenestrated endografts, such as the Nexus Duo for the aortic arch, now allow endovascular treatment of even the most complex aneurysms.
Comparison of the two methods
| Criterion | Endovascular (EVAR/TEVAR) | Open repair |
|---|---|---|
| Access | Punctures in the femoral artery | Abdominal or chest incision |
| Hospital stay | Usually 1-3 days | Usually 5-10 days |
| Recovery | 1-2 weeks | 4-8 weeks |
| Perioperative burden | Lower | Higher |
| Long-term follow-up | Regular imaging follow-up, possible reinterventions | Less frequent follow-up, high durability |
| Suitability | Requires suitable anatomy | Applicable to almost any anatomy |
Which method is preferred today
In modern vascular surgery, endovascular repair is the first choice when the anatomy of the aneurysm allows it. It is preferred particularly in older patients or those with comorbidities, because of the lower perioperative burden. Open repair remains an excellent option for younger patients at low surgical risk with a long life expectancy, and also when the anatomy is not suitable for an endograft. In complex cases hybrid procedures combine elements of both methods in the same session.
The role of the hybrid operating room
The decision is never standardised - it requires a vascular surgeon with experience in both techniques and infrastructure that supports them. At the IGS7 hybrid operating room of the Athens Medical Center, all the options are available in the same room, so that the treatment is adapted to the patient rather than the patient to the available technique. If you already have a diagnosis of an aneurysm and would like a documented opinion on the best method, you can request Second Opinion.
Frequently Asked Questions
Which aneurysm repair method is safer?
Endovascular repair has a lower perioperative burden and faster recovery, which is why it is preferred when the anatomy of the aneurysm allows it, particularly in older patients or those with comorbidities. Open repair remains an extremely durable solution in the long term. The final choice is made individually by the vascular surgeon.
How long does recovery take with each method?
After endovascular repair, the hospital stay usually lasts 1-3 days and return to activities takes place within 1-2 weeks. After open surgery, the hospital stay usually lasts 5-10 days and full recovery 4-8 weeks, depending on the patient.
Which vascular surgeon in Athens specialises in both methods?
Theodosios Bisdas, Associate Professor of Vascular Surgery and Director of the 3rd Vascular Surgery Department of the Athens Medical Center, performs endovascular as well as open and hybrid aneurysm repairs in the hybrid operating room of the Athens Medical Center, selecting the most appropriate method for each patient on an individual basis.
