Endovascular repair of AAA vs no repair

January 01, 0001

Endovascular repair of AAA vs no repair

Endovascular repair of abdominal aortic aneurysm was originally developed for patients who were considered to be physically ineligible for open surgical repair. Data are lacking on the question of whether endovascular repair reduces the rate of death among these patients. These UK investigators randomly assigned 404 patients with large abdominal aortic aneurysms (5.5 cm in diameter) who were considered to be physically ineligible for open repair to undergo either endovascular repair or no repair. Patients were followed for rates of death, graft-related complications and reinterventions, and costs.

They found: "The 30-day operative mortality was 7.3% in the endovascular-repair group. The overall rate of aneurysm rupture in the no- intervention group was 12.4 per 100 person-years. Aneurysm-related mortality was lower in the endovascular-repair group (adjusted hazard ratio, 0.53). This advantage did not result in any benefit in terms of total mortality (adjusted hazard ratio, 0.99). A total of 48% of patients who survived endovascular repair had graft-related complications, and 27% required reintervention within the first 6 years. During 8 years of follow-up, endovascular repair was considerably more expensive than no repair (cost difference, £9,826 {U.S. $14,867})."

The authors concluded: "In this randomized trial involving patients who were physically ineligible for open repair, endovascular repair of abdominal aortic aneurysm was associated with a significantly lower rate of aneurysm-related mortality than no repair. However, endovascular repair was not associated with a reduction in the rate of death from any cause. The rates of graft-related complications and reinterventions were higher with endovascular repair, and it was more costly."

The decision-making becomes quite complex given these trade- offs.

For the full abstract, click here.

N Engl J Med 362(20):1872-1880, 20 May 2010 © 2010 to the Massachusetts Medical Society
Endovascular Repair of Aortic Aneurysm in Patients Physically Ineligible for Open Repair. Roger M. Greenhalgh, Louise C. Brown, Janet T. Powell, Simon G. Thompson, David Epstein for The United Kingdom EVAR Trial Investigators. Correspondence to Dr. Greenhalgh: [email protected]

Category: K. Circulatory. Keywords: abdominal aortic aneurism, AAA, endovascular repair, mortality, reintervention, cost, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 8 June 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.