Endovascular versus open repair of abdominal aortic aneurysm
United Kingdom EVAR Trial Investigators, Roger M Greenhalgh, Louise C Brown, Janet T Powell, Simon G Thompson, David Epstein, Mark J Sculpher, R M Greenhalgh, D J Allison, P R F Bell, M J Buxton, P L Harris, B R Hopkinson, J T Powell, I T Russell, S G Thompson, L C Brown, L C Brown, D Epstein, M J Sculpher, S G Thompson, R M Greenhalgh, J D Beard, M J Buxton, P L Harris, J T Powell, J D G Rose, I T Russell, M J Sculpher, S G Thompson, R J Lilford, P R F Bell, R M Greenhalgh, S C Whitaker, P A Poole-Wilson, C V Ruckley, W B Campbell, M R E Dean, M S T Ruttley, E C Coles, J T Powell, A Halliday, S Gibbs, H D Dorricott, K Varty, C Cousins, R J Hannon, L Johnston, A W Bradbury, M J Henderson, S D Parvin, D F C Shepherd, R M Greenhalgh, A W Mitchell, P R Edwards, G T Abbott, D J Higman, A Vohra, S Ashley, C Robottom, M G Wyatt, J D G Rose, D Byrne, R Edwards, D P Leiberman, D H McCarter, P R Taylor, J F Reidy, A R Wilkinson, D F Ettles, A E Clason, G L S Leen, N V Wilson, M Downes, S R Walker, J M Lavelle, M J Gough, S McPherson, D J A Scott, D O Kessell, R Naylor, R Sayers, N G Fishwick, P L Harris, D A Gould, M G Walker, N C Chalmers, A Garnham, M A Collins, J D Beard, P A Gaines, M Y Ashour, R Uberoi, B Braithwaite, S C Whitaker, J N Davies, S Travis, G Hamilton, A Platts, A Shandall, B A Sullivan, M Sobeh, M Matson, A D Fox, R Orme, W Yusef, T Doyle, M Horrocks, J Hardman, P H B Blair, P K Ellis, G Morris, A Odurny, R Vohra, M Duddy, M Thompson, T M L Loosemore, A M Belli, R Morgan, M Adiseshiah, J A S Brookes, C N McCollum, R Ashleigh, M Aukett, S Baker, E Barbe, N Batson, J Bell, J Blundell, D Boardley, S Boyes, O Brown, J Bryce, M Carmichael, T Chance, J Coleman, C Cosgrove, G Curran, T Dennison, C Devine, N Dewhirst, B Errington, H Farrell, C Fisher, P Fulford, M Gough, C Graham, R Hooper, G Horne, L Horrocks, B Hughes, T Hutchings, M Ireland, C Judge, L Kelly, J Kemp, A Kite, M Kivela, M Lapworth, C Lee, L Linekar, A Mahmood, L March, J Martin, N Matharu, K McGuigen, P Morris-Vincent, S Murray, A Murtagh, G Owen, V Ramoutar, C Rippin, J Rowley, J Sinclair, S Spencer, V Taylor, C Tomlinson, S Ward, V Wealleans, J West, K White, J Williams, L Wilson, United Kingdom EVAR Trial Investigators, Roger M Greenhalgh, Louise C Brown, Janet T Powell, Simon G Thompson, David Epstein, Mark J Sculpher, R M Greenhalgh, D J Allison, P R F Bell, M J Buxton, P L Harris, B R Hopkinson, J T Powell, I T Russell, S G Thompson, L C Brown, L C Brown, D Epstein, M J Sculpher, S G Thompson, R M Greenhalgh, J D Beard, M J Buxton, P L Harris, J T Powell, J D G Rose, I T Russell, M J Sculpher, S G Thompson, R J Lilford, P R F Bell, R M Greenhalgh, S C Whitaker, P A Poole-Wilson, C V Ruckley, W B Campbell, M R E Dean, M S T Ruttley, E C Coles, J T Powell, A Halliday, S Gibbs, H D Dorricott, K Varty, C Cousins, R J Hannon, L Johnston, A W Bradbury, M J Henderson, S D Parvin, D F C Shepherd, R M Greenhalgh, A W Mitchell, P R Edwards, G T Abbott, D J Higman, A Vohra, S Ashley, C Robottom, M G Wyatt, J D G Rose, D Byrne, R Edwards, D P Leiberman, D H McCarter, P R Taylor, J F Reidy, A R Wilkinson, D F Ettles, A E Clason, G L S Leen, N V Wilson, M Downes, S R Walker, J M Lavelle, M J Gough, S McPherson, D J A Scott, D O Kessell, R Naylor, R Sayers, N G Fishwick, P L Harris, D A Gould, M G Walker, N C Chalmers, A Garnham, M A Collins, J D Beard, P A Gaines, M Y Ashour, R Uberoi, B Braithwaite, S C Whitaker, J N Davies, S Travis, G Hamilton, A Platts, A Shandall, B A Sullivan, M Sobeh, M Matson, A D Fox, R Orme, W Yusef, T Doyle, M Horrocks, J Hardman, P H B Blair, P K Ellis, G Morris, A Odurny, R Vohra, M Duddy, M Thompson, T M L Loosemore, A M Belli, R Morgan, M Adiseshiah, J A S Brookes, C N McCollum, R Ashleigh, M Aukett, S Baker, E Barbe, N Batson, J Bell, J Blundell, D Boardley, S Boyes, O Brown, J Bryce, M Carmichael, T Chance, J Coleman, C Cosgrove, G Curran, T Dennison, C Devine, N Dewhirst, B Errington, H Farrell, C Fisher, P Fulford, M Gough, C Graham, R Hooper, G Horne, L Horrocks, B Hughes, T Hutchings, M Ireland, C Judge, L Kelly, J Kemp, A Kite, M Kivela, M Lapworth, C Lee, L Linekar, A Mahmood, L March, J Martin, N Matharu, K McGuigen, P Morris-Vincent, S Murray, A Murtagh, G Owen, V Ramoutar, C Rippin, J Rowley, J Sinclair, S Spencer, V Taylor, C Tomlinson, S Ward, V Wealleans, J West, K White, J Williams, L Wilson
Abstract
Background: Few data are available on the long-term outcome of endovascular repair of abdominal aortic aneurysm as compared with open repair.
Methods: From 1999 through 2004 at 37 hospitals in the United Kingdom, we randomly assigned 1252 patients with large abdominal aortic aneurysms (> or = 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. Logistic regression and Cox regression were used to compare outcomes in the two groups.
Results: 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; 95% confidence interval [CI], 0.18 to 0.87; P=0.02). 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; 95% CI, 0.57 to 1.49; P=0.73). 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; 95% CI, 0.86 to 1.23; P=0.72). 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.
Conclusions: 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. (Current Controlled Trials number, ISRCTN55703451.)
2010 Massachusetts Medical Society
Source: PubMed