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Another Trial of Endovascular vs. Open Repair of AAA

In several ongoing trials, investigators are comparing endovascular and open approaches for elective repair of abdominal aortic aneurysms (AAAs). Recently, U.K. researchers published initial results from one of these studies, the EVAR-1 trial (Journal Watch Sep 10 2004). Now, Dutch investigators report early outcomes from a second study (the DREAM trial), in which 345 patients with AAAs of at least 5 cm in diameter were randomized to endovascular or open repair. All patients were suitable candidates for either procedure.

The primary endpoint -- a composite of 30-day operative mortality and moderate or severe complications -- occurred in 24% of open repair patients and in 18% of endovascular repair patients (P=0.23). Procedure-related mortality rates were 4.6% in the open repair group and 1.2% in the endovascular repair group (P=0.10). Cardiac and pulmonary complications occurred significantly more often after open repair than after endovascular procedures, whereas vascular and implant-related complications occurred significantly more often after endovascular repair.

Comment: Procedure-related mortality rates in this trial and in the recently published U.K. trial were almost identical. Thus, short-term outcomes appear to favor endovascular repair of AAA. For endovascular repair to maintain a decisive advantage over open repair, long-term graft-related complications in the endovascular groups -- which will be reported eventually -- must remain acceptably low.

— Allan S. Brett, MD

Published in Journal Watch General Medicine October 29, 2004

Citation(s):

Prinssen M et al. A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med 2004 Oct 14; 351:1607-18.

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