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

Methods: Single-centre retrospective study of consecutive patients less than 70 years old with primary IRAAA and JRAAA treated by OSR and EVAR between January 2010 and December 2021. Primary endpoint was 30-day mortality. Secondary end points were survival and freedom from re-intervention. Data are presented as median (IQR). A p-value of < .05 was considered significant.

Results: 230 patients [214 men; median age 65 years (64-67)] 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 was 0.9% (n=2). Major non-fatal complications occurred in 2.4% (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 re-operation (n=5; OSR 2 vs. EVAR 3). Median critical care and total hospital stay was: OSR 2 days (1-2) and 6 days (4-7); EVAR 1 day (0-1) and 2 days (1-3) (p<.001). Median follow-up was 90 months (59-121). Estimated 5-year survival (±SE) and freedom from late re-intervention were 89% ±2% and 88%±2%, respectively, with no difference related to modality of repair (p=.53) or aneurysm extent (p=.25).

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