From the publishers of The New England Journal of Medicine

Save time and stay informed. Our physician-editors offer you clinical perspectives on key research and news.

  1. Home>
  2. Specialties>
  3. General Medicine>
  4. Summary and Comment

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.

Your Remark:

Reader Remarks are intended to encourage lively discussion of clinical topics with your peers in the medical community. Please consider this when composing your remark.

Fields marked with an * are required.

Name as you'd like it to appear:

Submitting a comment indicates you have read and agreed to the remark guidelines and declare:*

PRIVACY: We will not use your email address, submitted for a comment, for any other purpose nor sell, rent, or share your e-mail address with any third parties. Please see our Privacy Policy.

 

CLEAR erases anything you've added in any part of the form. CONTINUE allows you to check your entire post (and edit it if necessary) before submitting.

To ensure that your Reader Remark is not formatted as one long paragraph, precede new paragraphs with either a blank line or an indentation.

Search

Advanced

Article Tools

Reader Remarks

Sign-In

Forgot your password?

New to Journal Watch?

E-mail Alerts

Delivered to your inbox.
Tailored to your interests. Free.

Sign Up Now!

Journal Watch Newsletters

Available in 13 specialties with convenient delivery and 10 free online CME exams.

Subscribe Now!

Copyright © 2004. Massachusetts Medical Society. All rights reserved.