A 15-Year Single-Center Experience Treating Complex Aortic Aneurysms: Transitioning From Open to Complex Endovascular Repair

Although less invasive compared to OSR regarding complications, complex EVAR still comes with considerable risks. For some frailest patients, complex EVAR might be a bridge too far. Specific insights in patient selection are warranted.Clinical ImpactWith the introduction of complex EVAR, more complex aneurysms were treated, in an overall frailer patient cohort. The frailest complex EVAR patients had a high 1-year mortality and a significantly lower mean survival compared to fit complex EVAR patients and patients undergoing OSR. The current selection process seems effective in recognizing the frailest patients and assigning them to complex EVAR, as guidelines propose. However, it might not yet be able to select patients that would benefit more from conservative non-surgical management. Specific insights in patient selection are warranted.