Open Versus Endovascular Repair (OVER) Veterans Affairs Cooperative Study Group. Outcomes following endovascular vs open repair of abdominal aortic aneurysm: a randomized trial. JAMA. 2009 Oct 14;302(14):1535-42 [PMID 19826022]
- outcome flowing EVAR vs open repair (OR) of AAA
- primary outcomes – long term all-cause mortality
- secondary outcomes – procedure failure, length of stay, QOL, erectile dysfunction, procedure-related morbidity.
- n = 881
-> higher mortality in OR group @ 30 days
-> no different in mortality @ 2 years
-> no other differences between groups (procedure failure, secondary therapeutic procedures, aneurysm-related hospitalisations or 1 year mortality, other morbidities)
-> EVAR group: shorter procedure, less blood loss, lower transfusions, shorter duration of MV, shorter hospital stay, ICU stay HOWEVER, extensive fluoroscopy + exposure to contrast.-> initial short term survival advantage of EVAR was offset by the need for frequent re-intervention, repeat CT and repeat clinic visits and no difference @ 2 years.
-> However, with increasing technology and improved techniques they will be standard of care for patients with larger aneurysms and those with IHD.
Greenhalgh, M.D., et al Endovascular repair of aortic aneurysm in patients physically ineligible for open repair. N Engl J Med. 2010 May 20;362(20):1872-80. [PMID 20382982]
- n = 404
- endovascular repair vs no repair
- inclusion criteria: those physically unable to undergo open repair, age > 60, AAA > 5.5cm
- primary end points = death from any cause, aneurysm related death, graft related complications, reinterventions
- no differences between the groups
- secondary end points = cost
-> operative mortality = 7.3%
-> aneurysm related mortality was slightly lower in the EVAR group (P = 0.02)
-> no difference in total mortality
-> higher graft related complications (minimal 6 months post repair)
-> higher reintervention
-> more cost with EVAR
-> statins are good!
…and the follow up…
EVAR Trial Investigators. Endovascular Repair of Abdominal Aortic Aneurysm in Patients Physically Ineligible for Open Repair: Very Long-term Follow-up in the EVAR-2 Randomized Controlled Trial. Ann Surg. 2017 Nov;266(5):713-719. [PMID 28742684]