TY - JOUR
T1 - Endovascular versus Open Repair of Abdominal Aortic Aneurysm
AU - Greenhalgh, Roger M.
AU - Brown, Louise C.
AU - Powell, Janet T.
AU - Thompson, Simon G.
AU - Epstein, David
AU - Sculpher, Mark J.
AU - United Kingdom EVAR Trial Investi
PY - 2010/5/20
Y1 - 2010/5/20
N2 - 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 (>= 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 endo-graft 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.)
AB - 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 (>= 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 endo-graft 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.)
KW - RANDOMIZED CONTROLLED-TRIAL
KW - EVAR
KW - POPULATION
KW - MORTALITY
KW - OUTCOMES
UR - http://www.scopus.com/inward/record.url?scp=77952653434&partnerID=8YFLogxK
U2 - 10.1056/NEJMoa0909305
DO - 10.1056/NEJMoa0909305
M3 - Article
SN - 0028-4793
VL - 362
SP - 1863
EP - 1871
JO - New England Journal of Medicine
JF - New England Journal of Medicine
IS - 20
ER -