Effects of study design and trends for EVAR versus OSR

Hopkins, Robert; Bowen, James M.; Campbell, Kaitryn; Blackhouse, Gord; Rose, Guy De; Novick, Teresa; O’Reilly, Daria; Goeree, Ron; Tarride, Jean‐Éric

doi:10.2147/vhrm.s3810

Cited by 19 publications

(21 citation statements)

References 103 publications

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“…tantly, with rapidly evolving technology such as endovascular surgery, outcomes may change over time, rendering results of some previous RCTs obsolete. 8 Well-designed retrospective cohort studies of open repair yield results that are both valid 9 and more broadly generalizable than the results of RCTs. The objective of this study was to compare overall and AAA-specific mortality, readmission, and reintervention after endovascular vs open repair of intact AAA in a cohort of Medicare beneficiaries.…”

mentioning

confidence: 99%

Comparison of Long-term Survival After Open vs Endovascular Repair of Intact Abdominal Aortic Aneurysm Among Medicare Beneficiaries

Jackson

Chang

Freischlag

2012

JAMA

108

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mentioning

confidence: 99%

Comparison of Long-term Survival After Open vs Endovascular Repair of Intact Abdominal Aortic Aneurysm Among Medicare Beneficiaries

Jackson

Chang

Freischlag

2012

JAMA

108

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“…Given the constant refinement of devices and technology, results from large trials often describe an obsolete device or outdated practice pattern and are thus difficult to compare to contemporary practice. 7 …”

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confidence: 99%

Ten-year results of endovascular abdominal aortic aneurysm repair from a large multicenter registry

Chang

Goodney

Tucker

et al. 2013

Journal of Vascular Surgery

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Objective To assess outcomes after endovascular abdominal aortic aneurysm repair (EVAR) in an integrated health care system. Methods Between 2000 and 2010, 1736 patients underwent EVAR at 17 centers. Demographic data, comorbidities, and outcomes of interest were collected. EVAR in patients presenting with ruptured or symptomatic aneurysms was categorized as urgent; otherwise, it was considered elective. Primary outcomes were mortality and aneurysm-related mortality (ARM). Secondary outcomes were change in aneurysm sac size, endoleak status, major adverse events, and reintervention. Results Overall, the median age was 76 years (interquartile range, 70–81 years), 86% were male, and 82% were Caucasian. Most cases (93.8%) were elective, but urgent use of EVAR increased from 4% in the first 5 years to 7.3% in the last 5 years of the study period. Mean aneurysm size was 5.8 cm. Patients were followed for an average of 3 years (range, 1–11 years); 8% were lost to follow-up. Intraoperatively, 4.5% of patients required adjunctive maneuvers for endoleak, fixation, or flow-limiting issues. The 30-day mortality rate was 1.2%, and the perioperative morbidity rate was 6.6%. Intraoperative type I and II endoleaks were uncommon (2.3% and 9.3%, respectively). Life-table analysis at 5 years demonstrated excellent overall survival (66%) and freedom from ARM (97%). Postoperative endoleak was seen in 30% of patients and was associated with an increase in sac size over time. Finally, the total reintervention rate was 15%, including 91 instances (5%) of revisional EVAR. The overall major adverse event rate was 7.9% and decreased significantly from 12.3% in the first 5 years to 5.6% in the second 5 years of the study period (P < .001). Overall ARM was worse in patients with postoperative endoleak (4.1% vs 1.8%; P < .01) or in those who underwent reintervention (7.6% vs 1.6%; P < .001). Conclusions Results from a contemporary EVAR registry in an integrated health care system demonstrate favorable perioperative outcomes and excellent clinical efficacy. However, postoperative endoleak and the need for reintervention continue to be challenging problems for patients after EVAR. (J Vasc Surg 2013;58:324–32.)

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“…35 Recent evidence has reported no significant difference in long-term mortality between OSR and EVAR. 36 Nevertheless, OSR has to remain a standard procedure, which needs to be mastered by every vascular surgeon.…”

Section: Discussionmentioning

confidence: 99%

Long-term dilatation of polyester and expanded polytetrafluoroethylene tube grafts after open repair of infrarenal abdominal aortic aneurysms

Stollwerck

Kozłowski

Sandmann

et al. 2011

Journal of Vascular Surgery

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After a mean implantation of 6 years, the ePTFE/Gore, polyester/Braun, and polyester/Vascutek tube grafts presented with significant differences. The ePTFE grafts showed a stronger resistance against dilatation than the two types of polyester grafts. Owing to similar perioperative and postoperative courses, no advantage could be identified in any group concerning the overall outcome. Vascular implants for OSR of AAA made of ePTFE and polyester are safe, even after a long implantation time. Therefore, the choice of the suitable graft does not depend on its postimplantation dilative characteristics. The outcome is not likely to be connected with dilatation of the implanted graft, because a causal connection between graft dilatation and death cannot be made. The study does not offer a basis for the preference of one of the three graft types. Nevertheless, continuous ultrasound examinations should be performed after implantation of an aortic tube graft to identify possible problems arising from changes in the graft and the residual vascular branches over time.

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Effects of study design and trends for EVAR versus OSR

Cited by 19 publications

References 103 publications

Comparison of Long-term Survival After Open vs Endovascular Repair of Intact Abdominal Aortic Aneurysm Among Medicare Beneficiaries

Comparison of Long-term Survival After Open vs Endovascular Repair of Intact Abdominal Aortic Aneurysm Among Medicare Beneficiaries

Ten-year results of endovascular abdominal aortic aneurysm repair from a large multicenter registry

Long-term dilatation of polyester and expanded polytetrafluoroethylene tube grafts after open repair of infrarenal abdominal aortic aneurysms

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