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Endovascular vs. Open Repair of AAAs -- A Randomized Trial

The 30-day mortality rate after abdominal aortic aneurysm repair was decisively lower with endovascular procedures.

Endovascular repair of an abdominal aortic aneurysm (i.e., percutaneous placement of stent grafts via femoral artery catheters) is becoming a popular alternative to standard open repair. In a randomized, multicenter trial from the U.K., 1082 patients (mean age, 74) with AAAs measuring 5.5 cm underwent either endovascular or open repair electively. All AAAs were anatomically suitable for either procedure, and all patients were considered fit to undergo either procedure. In this report, the investigators present short-term mortality findings.

In intent-to-treat analyses, the 30-day all-cause postoperative mortality rate was significantly lower with endovascular repair than with open repair (1.7% vs. 4.7%), as was the median length of hospital stay (7 days vs. 12 days). During the 30-day follow-up, 2% of endovascular patients were converted to open repair, and about 3% required another procedure to correct endoleaks (i.e., leaks into the space between the graft and the aneurysmal sac). In the open-repair group, 3% required surgical reexploration.

Comment: In this trial -- probably the largest randomized comparison to date -- endovascular repair of AAAs was associated with a decisively lower 30-day mortality rate than was open repair. However, extrapolating the results to any given center or surgeon is no simple matter: The trial was conducted at both academic and community hospitals, and several different brands of endovascular devices were used. Given current uncertainty about the durability of endovascular repair, longer-term outcomes from this trial, which will be reported during the next few years, are eagerly anticipated.

— Allan S. Brett, MD

Published in Journal Watch General Medicine September 10, 2004

Citation(s):

The EVAR Trial Participants. Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: Randomised controlled trial. Lancet 2004 Sep 4; 364:843-8.

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