- EVAR I Trial (Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm )
Comparison of outcomes after open conventional vs. endovascular therapy of abdominal aortic aneurysms in the United Kingdom:
The 30-day mortality was significantly reduced in endovascular therapy (1.6% vs. 4.6%), but the secondary intervention rate was increased (9.8% vs. 5.8%). 1
In particular, the healthier patients benefited from it. 2
Four years after randomization, the overall mortality was comparable (28% each), the aneurysm-associated mortality after endovascular therapy remained reduced (4% vs. 7%). The complication rate was significantly increased after endovascular therapy (41% vs. 9%). Quality of life did not differ significantly 1 year after surgery. The average hospital costs were higher after endovascular therapy (13257 UK pound sterling vs. 9946 UK pound sterling). 3 - EVAR II Trial (Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm)
Assessment of outcomes after endovascular therapy of abdominal aortic aneurysms in patients classified as too sick for a conventional approach, compared to a conservative approach (no intervention):
The 30-day mortality after endovascular therapy was 9%, the rupture rate in untreated patients was 9/100 patient-years. After endovascular therapy, no significant improvement in overall mortality (64% after 4 years) or aneurysm-associated mortality was observed; however, it was considerably more expensive (13632 UK pound sterling vs. 4983 UK pound sterling). 4 - DREAM Trial (Dutch Randomised Endovascular Aneurysm Management)
Comparison of outcomes after open conventional vs. endovascular therapy of abdominal aortic aneurysms in the Netherlands:
Both the 30-day mortality (1.2% vs. 4.6%) and the combined rate of operative mortality and complications (4.7% vs. 9.8%) were significantly reduced after endovascular therapy. 5
The cumulative survival rate was nearly identical 2 years postoperatively after both surgical procedures (endovascular 89.7% vs. 89.6%). The cumulative rate of aneurysm-associated deaths was 2.1% after endovascular therapy and 5.7% after conventional surgery. This difference was solely due to the difference in direct postoperative events. The proportion of patients who showed no complications after 2 years was comparable (65.9 vs. 65.6%). 6
Following both surgical procedures, sexual function is impaired but recovers more quickly after endovascular therapy. After 3 months, the baseline situation is regained regardless of the approach. 7
Quality of life is better in the early postoperative phase after endovascular therapy, which changes in favor of the conventional approach after 6 months and beyond. 8
Endovascular therapy was more expensive by 4293€. 9 - OVER Trial (Open Versus Endovascular Repair (OVER) Veterans Affairs Cooperative Study Group)
Comparison of outcomes after open conventional vs. endovascular therapy of abdominal aortic aneurysms in the USA:
Endovascular therapy was associated with reduced perioperative mortality (0.5% vs. 3%), operative time (2.9 vs. 3.7 hours), blood loss (200 ml vs. 1000 ml), transfusion requirement (0 vs.1 unit), ventilation duration (3.6 vs. 5 hours), intensive care unit stay (1 vs. 4 days), and hospital stay (3 vs. 7 days). Regarding morbidity, treatment failure, secondary interventions, aneurysm-associated hospitalizations, quality of life, or erectile function, there were no differences between the therapy options. 10
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Summary of the Literature
Currently ongoing studies on this topic
CAESAR Trial: Comparison of surveillance vs Aortic Endografting for Small Aneurysm Repair Compariso
CAESAR Trial: Comparison of surveillance vs Aortic Endografting for Small Aneurysm Repair Compariso
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