A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms

Abstract

Although the initial results of endovascular repair of abdominal aortic aneurysms were promising, current evidence from controlled studies does not convincingly show a reduction in 30-day mortality relative to that achieved with open repair. methods We conducted a multicenter, randomized trial comparing open repair with endovascular repair in 345 patients who had received a diagnosis of abdominal aortic aneurysm of at least 5 cm in diameter and who were considered suitable candidates for both techniques. The outcome events analyzed were operative (30-day) mortality and two composite end points of operative mortality and severe complications and operative mortality and moderate or severe complications. results The operative mortality rate was 4.6 percent in the open-repair group (8 of 174 patients; 95 percent confidence interval, 2.0 to 8.9 percent) and 1.2 percent in the endovascular-repair group (2 of 171 patients; 95 percent confidence interval, 0.1 to 4.2 percent), resulting in a risk ratio of 3.9 (95 percent confidence interval, 0.9 to 32.9). The combined rate of operative mortality and severe complications was 9.8 percent in the open-repair group (17 of 174 patients; 95 percent confidence interval, 5.8 to 15.2 percent) and 4.7 percent in the endovascular-repair group (8 of 171 patients; 95 percent confidence interval, 2.0 to 9.0 percent), resulting in a risk ratio of 2.1 (95 percent confidence interval, 0.9 to 5.4). conclusions On the basis of the overall results of this trial, endovascular repair is preferable to open repair in patients who have an abdominal aortic aneurysm that is at least 5 cm in diameter. Long-term follow-up is needed to determine whether this advantage is sustained.

Treatment of complex aortic aneurysms with fenestrated endografts and chimney stent repair: Systematic review and meta-analysis

“…Standard EVAR represented an alternative to AAA for years, 52 with proven success. 53 However, it was only appropriate for infra-renal AAA with a long neck. The option for para-renal, thoracic or juxta-renal AAA was unclear.…”

The Nellix™ EndoVascular sealing system in patients with abdominal aortic aneurysms in conjunction with iliac artery occlusive disease

“…Aneurysmal aortic disease is accompanied with concomitant iliac artery occlusive pathology in a prevalence of 6–15.4% and is one of the factors precluding endovascular abdominal aneurysm repair (EVAR). 1,2 EVAR has become an established treatment modality as it reduces morbidity and early mortality compared to open surgical repair. 3,4 Current developments are focused on reducing reintervention rates and broadening applicability.…”

Internal iliac coverage during endovascular repair of abdominal aortic aneurysms is a safe option: A preliminary study

“…Benefits over open surgery include lower perioperative morbidity and mortality, and long-term safety. 1–4 With growing operator experience and improved devices, increasingly complex and challenging anatomy is being considered for endovascular repair.…”

“…In the majority of cases, the common iliac artery (CIA) is the ideal landing zone, preserving flow to both the internal iliac artery (IIA) and external iliac artery (EIA). 4…”