Endovascular and Open Surgical Repair of Intact Abdominal Aortic Aneurysms: Outcomes, Treatment Trends and Early Mortality Risk Factors in a Single-Centre Study over 18 Years

<b>Background</b>: Endovascular aortic repair (EVAR) has become the standard approach for intact abdominal aortic aneurysm (iAAA) repair in recent decades. This retrospective single-centre study analyzed real-world treatment trends, early outcomes, and risk factors for in-hospital mortality following EVAR and open surgical repair (OSR) in patients treated for iAAA from 2005 to 2022. <b>Methods</b>: In-hospital mortality was the primary outcome. Univariate and multivariable logistic regression analyses were performed. Logistic and logarithmic regression models were established to assess temporal changes. <b>Results</b>: In total, 1237 patients (90% male, mean age 72 years) were included, comprising 863 EVAR and 374 OSR procedures. In-hospital mortality was lower after EVAR than OSR (0.93% vs. 3.48%; <i>p</i> = 0.001). After risk adjustment, higher age (adjusted odds ratio [OR] 2.39, 95% confidence interval [CI] 1.26-4.78; <i>p</i> = 0.007) and chronic obstructive pulmonary disease (OR 4.43, 95% CI 1.82-10.8; <i>p</i> = 0.001) were associated with higher in-hospital mortality. Conversely, EVAR (vs. OSR; OR 0.16, 95% CI 0.06-0.43; <i>p</i> < 0.001) was associated with a lower hospital mortality risk. Throughout the study, in-hospital mortality rates for EVAR and OSR remained stable. With a median follow-up of 21 months, OSR-treated patients presented prolonged survival during follow-up (<i>p</i> = 0.021). <b>Conclusions</b>: EVAR represents a reliable alternative for elderly patients with multiple comorbidities considered unfit for OSR. Although EVAR was associated with lower in-hospital mortality, survival was lower during the 5-year follow-up compared to OSR.