Endovascular Aneurysm Repair Versus Open Repair in Patients With Abdominal Aortic Aneurysm (EVAR Trial i): Randomized Controlled Trial

Abstract

The authors report the results of a trial randomized controlled trial of 1082 patients aged 60 years or older with large abdominal aortic aneurysms (5.5 cm or larger in diameter) in which endovascular aneurysm repair (EVAR) was compared with open repair. The variables compared were cost, mortality, complications, durability, and health-related quality of life. At the 4-year follow-up, the two groups had similar rates of all-cause mortality, but the EVAR group had a persistent reduction in aneurysm-related deaths. In the EVAR group 41% had experienced a postoperative complication compared with 9% in the open repair group. At the end of 1 year, there were no differences in health-related quality of life. The authors concluded that EVAR is more expensive (about one third higher costs), has more complications and reinterventions, but offers a 3% better aneurysm-related survival.

Keywords

Endovascular aneurysm repair abdominal aortic aneurysm open repair EVAR 1 trial

Get full access to this article

View all access options for this article.

References

1. Rutherford RB , Krupski WC . Current status of open versus endovascular stent-graft repair of abdominal aortic aneurysm. J Vasc Surg 39:1129-1139, 2004.

2. Anderson PL , Arons RR , Moskowitz AJ , et al. A statewide experience with endovascular abdominal aortic aneurysm repair: rapid diffusion with excellent early results. J Vasc Surg 39:10-19, 2004.

3. Lee WA , Hirneise CM , Tayyarah M , Huber TS , Seeger JM . Impact of endovascular repair on early outcomes of ruptured abdominal aortic aneurysms. J Vasc Surg 40:211-215, 2004.

4. Leurs LJ , Hobo R , Buth J ; EUROSTAR Collaborators. The multicenter experience with a third-generation endovascular device for abdominal aortic aneurysm repair. A report from the EUROSTAR database. J Cardiovasc Surg (Torino) 45(4):293-300, 2004.

5. Blankensteijn JD , de Jong SE , Prinssen M , van der Ham AC , et al; Dutch Randomized Endovascular Aneurysm Management (DREAM) Trial Group. Two-year outcomes after conventional or endovascular repair of abdominal aortic aneurysms. N Engl J Med 352:2398-2405, 2005.

6. Lederle FA . Endovascular repair of abdominal aortic aneurysm-round two. N Engl J Med 352:2443-2445, 2005.

7. Lederle FA . Abdominal aortic aneurysm-open versus endovascular repair. N Engl J Med 351(16):1677-1679, 2004.