With the advent of artificial blood vessels in the 1950s, open surgery (OR) for abdominal aortic aneurysms has gradually matured, and after years of continuous improvement, the operative mortality rate has been reduced from 40 to 50% 20 years ago; to less than 5%; OR has withstood the test of more than half a century and has provided Aneurysm treatment has accumulated valuable experience. However, traditional surgery is very traumatic, making many patients with aneurysms with combined organ dysfunction unable to tolerate this treatment and die. Therefore, when the minimally invasive treatment method of endoluminal isolation (EVAR) emerged it has been widely used in clinical practice, and the treatment level of this method has been improving. But how to grasp the indications for both treatment modalities, what are the remaining problems with EVAR, can EVAR save all AAA patients, and can EVAR reduce mortality and complications of AAA better than OR? What is the near and long-term efficacy of the two approaches? The above questions are analyzed in comparison with the literature and our department’s research and personal experience to explore the status of OR in AAA treatment. 1. Exploring the status of OR from the indications for treatment Pei Ho meta-reported 27 relevant studies that included a total of 7226 AAA patients, of whom 4167 were treated with EVAR and 3059 were treated with OR. A number of these studies were randomized controlled trials, such as the EVAR trial, a multicenter randomized controlled clinical study in the United Kingdom on the comparison of endoluminal and conventional surgery for AAA (1999-2003), which included the EVAR trial 1 and EVAR trial 2; and the DREAM trial, the Dutch randomized endoluminal abdominal aortic aneurysm treatment program (2000-2003). Other studies on both are the OVER clinical trial in the United States and the French ACE study, which will have results at the end of this year. The clinical work and the literature show that the indications for both treatments have many similarities in terms of the purpose of treating AAA, as both are aimed at preventing aneurysm rupture or repairing a ruptured AAA, depending on the combination of clinical symptoms of the aneurysm, the size of the aneurysm diameter, the growth rate of the aneurysm (which should not exceed 11% per year;) or the presence of a precursor to aneurysm rupture. However, each method has its limitations. OR treatment is influenced by unstable angina, recent myocardial infarction and other cardiac diseases, respiratory diseases, and age. EVAR requires high anatomical conditions of the aneurysm, excessive distortion of the aneurysm neck (angle between the suprarenal segment of the aorta and the aneurysm neck ≥ 60°), aneurysm neck that is too short ≤ 10 mm, severe calcification of the aneurysm neck, thrombosis of the intimal appendage of the aneurysm neck, Stenosis and calcification of the iliac artery make treatment difficult. In addition, age less than 18 years, pregnancy or breastfeeding, and congenital degenerative collagen disease such as Marfan’s syndrome are difficult or even contraindicated for endoluminal treatment. pei Ho’s report concluded that EVAR is less invasive than OR and suitable for high-risk patients, but has high morphological requirements for AAA. Patients with complex aneurysms that cannot be treated with intervention; young patients with estimated longevity of abdominal aortic aneurysms; and patients with ruptured abdominal aortic aneurysms should still undergo conventional open surgery. 2.Discuss the status of OR from the complications of both treatments Classified according to the early and late occurrence, they are divided into early complications and intermediate and late complications. Early complications are those that occur during the same hospitalization or within 30 days after surgery and include intraoperative blood loss, transfusion volume, early secondary intervention rate, and intraoperative conversion to open abdomen during EVAR. Intermediate complications generally refer to complications occurring 30 days postoperatively or after the first discharge, and late complications if they are more than three years old. The mid- and late-term complications mainly include reoperation rate and complications of grafts. The hemodynamic changes during conventional surgery are large, and elderly patients, especially those with underlying diseases such as heart and kidney, have poor functional reserve of each organ, so the chances of difficult extubation of tracheal intubation, myocardial ischemia, and respiratory tract infection increase in the postoperative period. OR requires clear exposure of the operative field and large free trauma, which may bring about ischemic symptoms of the intestine. Endoluminal surgery has less impact on the gastrointestinal tract and faster recovery of gastrointestinal function after surgery; less respiratory impact and lower incidence of respiratory disorders; in addition, the EVAR incision is small, the chance of wound infection is reduced and the incidence of surgical incision complications is lower, thus it can be seen from the above early course of treatment that the perioperative complications of traditional surgery are higher than those of endoluminal treatment. 2.1, Intraoperative blood loss, transfusion volume, The results of almost all current studies show that the blood loss in the intracavitary group is significantly reduced, according to foreign statistics the blood loss in EVAR is 96~641ml, OR is 783~3400ml, thus it can be seen that traditional surgery due to blood loss ambassador transfusion possibility and transfusion volume should be significantly increased, while the intracavitary group does not need or need very small amount of blood input. 2.2. Early secondary intervention rate That is, re-surgical interventions occurring during the same hospitalization or within 30 days after surgery. The relative risk RR value for occurrence in the endoluminal group was 2.03 (95%; CI 1.04 to 3.95, P=0.04), indicating that endoluminal surgery has more early reintervention rates than conventional surgery. 2.3, Intraoperative conversion to open abdomen for EVAR For some AAA patients who were considered to be able to undergo EVAR by preoperative imaging, intraoperative difficulties in operation, inability to release stents, and abnormal guidewire catheters may occur, so there is a possibility of intraoperative conversion to row OR, which indicates that if endoluminal treatment is to be carried out, we must have the conditions and capabilities of open vascular surgery, and we cannot simply pursue minimally invasive and The results of the EVAR trial showed that the reoperation rates for the endoluminal and open surgery groups were 20% and 6%, respectively, with P < 0.0001. The DREAM trial showed that the reoperation rates for the two groups were 17% and 6%, respectively. Similar studies with trial results in different regions have reached consistent conclusions, which deserve our consideration and study. The data illustrate that the rate of surgical interventions intracavitary treatment in the middle and late stages is significantly higher, which not only increases the economic and mental burden of patients, but also increases the workload of medical staff and has the potential to generate medical disputes. 2.5. Complications of grafts Stent-related complications include imprecise placement, difficulty in dilation/balloon rupture, difficulty in insertion and extraction, occurrence of various types of endoleaks, formation of intra-stent thrombus, stent displacement, stent fracture, and rupture of aneurysms. Relatively fewer complications are associated with OR's large artery prosthetic vessels, such as thrombosis, prosthetic vessel infection, and intestinal endovascular fistula. With the advancement of technology, Pitton MB statistics of 10 years of endoluminal treatment results found that endoleaks <;10%; do not affect the reduction of aneurysm and complications. 3. Exploring the status of OR in terms of mortality and quality of life and cost-effectiveness 3.1. 30-day postoperative mortality More than 20 studies have reported 30-day postoperative mortality, among which the 30-day mortality in the EVAR trial was 1.7% in the endoluminal surgery group; (9/531) and 4.7% in the conventional surgery group; (24/516), p=0.009. The results of the DREAM trial were 1.2% in the endoluminal The results of the DREAM trial were 1.2% in the intracavitary group; and 4.6% in the conventional surgery group;, p=0.01. In addition, several studies have produced similar results showing the superiority of EVAR in this index, indicating where the advantages of EVAR lie. 3.2, Mortality from any cause and aneurysm-related mortality The results of the EVAR trial showed that mortality from any cause occurred in 26% in the luminal and 29% in the open surgery group; p=0.46; and aneurysm-related mortality was 4%; and 7%; p=0.04. The Lovegrove meta 21178 AAA patients found no difference in overall mortality between luminal repair and open surgery (0.94%). The DREAM trial showed 10.3% and 10.4% for each of the two indicators of death from any cause; P=0.86; and 5.7% in the open surgery group and 2.1% in the lumpectomy group for aneurysm-related mortality at two years; P=0.05. Compared to OR, EVAR had no advantage in terms of mortality from all types of causes, with more complications and retreatment, however, endoluminal surgery did have a 3%; reduction in aneurysm mortality. Long-term follow-up observations and more detailed evaluation are necessary. 3.3. Quality of life and cost-effectiveness Between 3 and 12 months after surgery in the EVAR trial, the quality of life was lower in the conventional surgery group than in the endoluminal treatment group, but after 12 months, the difference in healthy quality of life scores between the two groups was negligible. In terms of quality of life, the Dream trial showed no difference at six months postoperatively. 27 clinical trials, most of which focused on short-term clinical outcomes and details, with only 15 studies addressing medium- and long-term outcomes, and EVAR has not been shown to be superior in terms of medium-term outcomes. The difference was £3,311, compared with £9,946 for conventional surgery. Of the 223 patients with abdominal aortic aneurysms at Anzhen Hospital, the total cost during hospitalization was$58,200±20,400 in the open surgery group and$124,600±49,700 in the endoluminal repair group, which was significantly different (P<;0.01), and the endoluminal treatment group required a repeat CTA during follow-up, as well as a higher frequency of review than the surgical group, resulting in higher costs. The intracavitary repair group was significantly higher than the open surgery group, and the main difference came from the manual consumables, which is a specific reflection of our national situation. While the cost of medical staff labor is significantly higher than the cost of medical consumables in Western developed countries, the cost of medical staff labor accounts for a rather small percentage of the hospitalization cost of patients in China, while the vast majority of the cost comes from medical consumables and drugs. Therefore, the cost-effectiveness of EVAR in China is significantly worse than that of OR. The significant advantages of EVAR as a minimally invasive approach to treat aortic dilated disease are less trauma, lower 30-day mortality, shorter hospital stay, less bleeding and transfusion, fewer postoperative cardiopulmonary complications, less colonic ischemia, and faster postoperative recovery. EVAR is a good choice in terms of short-term results; however, it has early disadvantages such as high incidence of secondary reinterventions and graft complications such as endoleaks, blockages, and displacements. In addition, for patients who are too old and frail for conventional surgery, there is a significant increase in postoperative mortality with endoluminal surgery compared to conservative treatment. Approximately more than 20%; of patients are not suitable for EVAR, and it is not yet possible to completely replace OR with EVAR. Endoluminal surgery not only does not improve survival, but also requires more observation and retreatment, substantially increasing the cost of treatment. Therefore further follow-up and improvement of the general condition of these patients are important factors that need to be prioritized for EVAR surgery. In conclusion, both endoluminal and surgical treatments have a continuous process of development and improvement. ManiK counted 12,834 AAA patients in the last 20 years in June this year, and the overall cure rate of AAA is increasing year by year, regardless of the surgical approach. We should strictly grasp the surgical indications and objectively evaluate both treatments according to our own technical strength and specific conditions. We should strive to improve the endoluminal technique while not discarding the traditional open surgical treatment, only then can we combine both organically for innovative hybrid surgery when necessary and individualize the treatment for different patients according to the actual situation, so as to take a new step forward for the treatment of abdominal aortic aneurysm. This is a new step in the treatment of abdominal aortic aneurysms.