BACKGROUND: Several studies, including three randomized controlled trials (RCTs), have shown that endovascular repair (EVAR) of abdominal aortic aneurysms (AAA) offered better early results than open surgical repair (OSR) but a similar medium-term to long-term mortality and a higher incidence of reinterventions. Thus, the role of EVAR, most notably in low-risk patients, remains debated. METHODS: The ACE (Anevrysme de l'aorte abdominale: Chirurgie versus Endoprothese) trial compared mortality and major adverse events after EVAR and OSR in patients with AAA anatomically suitable for EVAR and at low-risk or intermediate-risk for open surgery. A total of 316 patients with >5 cm aneurysms were randomized in institutions with proven expertise for both treatments: 299 patients were available for analysis, and 149 were assigned to OSR and 150 to EVAR. Patients were monitored for 5 years after treatment. Statistical analysis was by intention to treat. RESULTS: With a median follow-up of 3 years (range, 0-4.8 years), there was no difference in the cumulative survival free of death or major events rates between OSR and EVAR: 95.9% ± 1.6% vs 93.2% ± 2.1% at 1 year and 85.1% ± 4.5% vs 82.4% ± 3.7% at 3 years, respectively (P = .09). In-hospital mortality (0.6% vs 1.3%; P = 1.0), survival, and the percentage of minor complications were not statistically different. In the EVAR group, however, the crude percentage of reintervention was higher (2.4% vs 16%, P < .0001), with a trend toward a higher aneurysm-related mortality (0.7% vs 4%; P = .12). CONCLUSIONS: In patients with low to intermediate risk factors, open repair of AAA is as safe as EVAR and remains a more durable option.
RCT Entities:
BACKGROUND: Several studies, including three randomized controlled trials (RCTs), have shown that endovascular repair (EVAR) of abdominal aortic aneurysms (AAA) offered better early results than open surgical repair (OSR) but a similar medium-term to long-term mortality and a higher incidence of reinterventions. Thus, the role of EVAR, most notably in low-risk patients, remains debated. METHODS: The ACE (Anevrysme de l'aorte abdominale: Chirurgie versus Endoprothese) trial compared mortality and major adverse events after EVAR and OSR in patients with AAA anatomically suitable for EVAR and at low-risk or intermediate-risk for open surgery. A total of 316 patients with >5 cm aneurysms were randomized in institutions with proven expertise for both treatments: 299 patients were available for analysis, and 149 were assigned to OSR and 150 to EVAR. Patients were monitored for 5 years after treatment. Statistical analysis was by intention to treat. RESULTS: With a median follow-up of 3 years (range, 0-4.8 years), there was no difference in the cumulative survival free of death or major events rates between OSR and EVAR: 95.9% ± 1.6% vs 93.2% ± 2.1% at 1 year and 85.1% ± 4.5% vs 82.4% ± 3.7% at 3 years, respectively (P = .09). In-hospital mortality (0.6% vs 1.3%; P = 1.0), survival, and the percentage of minor complications were not statistically different. In the EVAR group, however, the crude percentage of reintervention was higher (2.4% vs 16%, P < .0001), with a trend toward a higher aneurysm-related mortality (0.7% vs 4%; P = .12). CONCLUSIONS: In patients with low to intermediate risk factors, open repair of AAA is as safe as EVAR and remains a more durable option.
Authors: S L Zettervall; S E Deery; P A Soden; K Shean; J J Siracuse; M Alef; V I Patel; M L Schermerhorn Journal: Eur J Vasc Endovasc Surg Date: 2017-08-02 Impact factor: 7.069
Authors: Hui-Fang Zhou; Huimin Yan; Cordula M Stover; Tamara Montes Fernandez; Santiago Rodriguez de Cordoba; Wen-Chao Song; Xiaobo Wu; Robert W Thompson; Wilhelm J Schwaeble; John P Atkinson; Dennis E Hourcade; Christine T N Pham Journal: Proc Natl Acad Sci U S A Date: 2012-01-30 Impact factor: 11.205
Authors: Rui Machado; Vitor Miguel Dias Ferreira; Luis Loureiro; João Gonçalves; Pedro Oliveira; Rui Almeida Journal: Braz J Cardiovasc Surg Date: 2016 Nov-Dec
Authors: P K Gupta; B Ramanan; T G Lynch; H Gupta; X Fang; M Balters; J M Johanning; G M Longo; J N MacTaggart; I I Pipinos Journal: Eur J Vasc Endovasc Surg Date: 2012-03-03 Impact factor: 7.069
Authors: Dmitriy I Dovzhanskiy; Maani Hakimi; Moritz S Bischoff; Caro la M Wieker; Thilo Hackert; Dittmar Böckler Journal: Chirurg Date: 2020-02 Impact factor: 0.955