Outcomes with endovascular vs open repair of AAA

January 01, 0001

Outcomes with endovascular vs open repair of AAA

From 1999 through 2004 at 37 hospitals in the United Kingdom, these UK investigators randomly assigned 1252 patients with large abdominal aortic aneurysms (5.5 cm in diameter) to undergo either endovascular or open repair; 626 patients were assigned to each group. Patients were followed for rates of death, graft-related complications, reinterventions, and resource use until the end of 2009.

They found: "The 30-day operative mortality was 1.8% in the endovascular-repair group and 4.3% in the open-repair group (adjusted odds ratio for endovascular repair as compared with open repair, 0.39). The endovascular-repair group had an early benefit with respect to aneurysm- related mortality, but the benefit was lost by the end of the study, at least partially because of fatal endograft ruptures (adjusted hazard ratio, 0.92). By the end of follow-up, there was no significant difference between the two groups in the rate of death from any cause (adjusted hazard ratio, 1.03). The rates of graft-related complications and reinterventions were higher with endovascular repair, and new complications occurred up to 8 years after randomization, contributing to higher overall costs."

The authors concluded: "In this large, randomized trial, endovascular repair of abdominal aortic aneurysm was associated with a significantly lower operative mortality than open surgical repair. However, no differences were seen in total mortality or aneurysm-related mortality in the long term. Endovascular repair was associated with increased rates of graft- related complications and reinterventions and was more costly."

This is important information for patients, physicians, and health care systems.

For the full abstract, click here.

N Engl J Med 362:1863-1871, 20 May 2010
© 2010 to the Massachusetts Medical Society
Endovascular versus Open Repair of Abdominal Aortic Aneurysm. Roger M. Greenhalgh, Louise C. Brown, Janet T. Powell, Simon G. Thompson, David Epstein, Mark J. Sculpher, for The United Kingdom EVAR Trial Investigators. Correspondence to Dr. Greenhalgh: [email protected]

Category: K. Circulatory. Keywords: abdominal aortic aneurism, AAA, endovascular repair, open 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.