Long-term outcome of open vs endovascular repair of AAA

January 01, 0001

Long-term outcome of open vs endovascular repair of AAA

These Dutch investigators conducted a long-term, multicenter, randomized, controlled trial comparing open repair with endovascular repair in 351 patients with an abdominal aortic aneurysm of at least 5 cm in diameter who were considered suitable candidates for both techniques. The primary outcomes were rates of death from any cause and reintervention. Survival was calculated with the use of Kaplan-Meier methods on an intention-to-treat basis.

They found: "We randomly assigned 178 patients to undergo open repair and 173 to undergo endovascular repair. Six years after randomization, the cumulative survival rates were 69.9% for open repair and 68.9% for endovascular repair (difference, 1.0 percentage point (NS). The cumulative rates of freedom from secondary interventions were 81.9% for open repair and 70.4% for endovascular repair (difference, 11.5 percentage points (significant)."

The authors concluded: "Six years after randomization, endovascular and open repair of abdominal aortic aneurysm resulted in similar rates of survival. The rate of secondary interventions was significantly higher for endovascular repair."

Although short term survival may be better with endovascular repair of AAA, by six years later this benefit is lost.

For the full abstract, click here.

N Engl J Med 362(20):1881-1889, 20 May 2010
© 2010 to the Massachusetts Medical Society
Long-Term Outcome of Open or Endovascular Repair of Abdominal Aortic Aneurysm. Jorg L. De Bruin, Annette F. Baas, Jaap Buth, et al. Correspondence to Dr. J. Blankensteijn: [email protected]

Category: Keywords: abdominal aortic aneurism, AAA, endovascular repair, open repair, mortality, reintervention, 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.