Objective: To report the outcome of elective open surgical repair (OSR) and endovascular repair (EVAR) of primary infrarenal (IR) and juxtarenal (JR) abdominal aortic aneurysms (AAA) in patients <70 years of age.

Methods: Single-center retrospective study of consecutive patients <70 years old with primary IRAAA and JRAAA treated by OSR and EVAR between January 2010 and December 2021. The primary end point was 30-day mortality. Secondary end points were survival and freedom from reintervention. Data are presented as median (interquartile range [IQR]). A P value of <.05 was considered significant.

Results: We included 230 patients (214 men; median age 65 years; range, 64-67 years) who underwent repair of IRAAA (n = 133; 53 OSR, 80 EVAR) and JRAAA (n = 97; 30 OSR, 67 fenestrated EVAR). Coronary artery disease was more prevalent in EVAR patients (48% vs OSR, 23%; P < .001) and those with JRAAA (51% vs IRAAA: 31%; P = .003). The 30-day mortality rate was 0.9% (n = 2). Major nonfatal complications occurred in 2.4% of patients (2/83) after OSR and 3.4% (5/147) after EVAR: myocardial infarction (n = 1; OSR), temporary renal replacement therapy (n = 1; OSR), respiratory failure requiring prolonged ventilation (n = 2; EVAR), and reoperation (n = 5; OSR 2 vs EVAR 3). The median critical care and total hospital stay was as follows: OSR 2 days (IQR, 1-2 days) and 6 days (IQR, 4-7 days); EVAR 1 day (IQR, 0-1 day) and 2 days (IQR, 1-3 days) (P < .001). The median follow-up was 90 months (IQR, 59-121 months). Estimated 5-year survival (± standard error) and freedom from late reintervention were 89% ± 2% and 88% ± 2%, respectively, with no difference related to modality of repair (P = .53) or aneurysm extent (P = .25).

Conclusions: IR EVAR, fenestrated EVAR, and OSR are associated with excellent early and mid-term outcomes in appropriately selected younger patients with IR and JR AAA.