BACKGROUND: The endovascular treatment of abdominal aortic aneurysms has become more common. A careful comparison of this technique with the established treatment by open surgery is needed before it can be more widely adopted. METHODS: We selectively searched the Medline database for articles on the endovascular treatment of abdominal aortic aneurysms, with special attention to prospective, randomized trials comparing it to open aortic surgery (keywords: "endovascular abdominal aortic repair" and "prospective randomized trial"). RESULTS: Data on 30-day mortality and long-term survival are now available from four randomized multicenter trials. In three of these trials, endovascular treatment was found to lower 30-day mortality by two-thirds (endovascular: 0.2% to 1.7%, open repair: 0.7% to 4.7%), but this difference in survival was no longer present at two years. Compared to open open aortic surgery, endovascular treatment has a higher long-term complication rate. Endoleakage (perigraft leakage) accounted for more than 30% of complications and was the commonest reason for reintervention and unsuccessful intervention; in nearly all cases, it was successfully treated by the endovascular route. The rate of secondary aortic rupture was 0.8%, and migration of the prosthesis occurred in 5% of cases. Follow-up checks of the stent graft are now recommended at 3, 6 and 12 months after implantation, and annually thereafter. CONCLUSION: Prospective randomized trials have shown that the endovascular technique lowers perioperative mortality. In the long term, however, it has a higher complication rate than open aortic surgery and leads to more frequent reintervention.
BACKGROUND: The endovascular treatment of abdominal aortic aneurysms has become more common. A careful comparison of this technique with the established treatment by open surgery is needed before it can be more widely adopted. METHODS: We selectively searched the Medline database for articles on the endovascular treatment of abdominal aortic aneurysms, with special attention to prospective, randomized trials comparing it to open aortic surgery (keywords: "endovascular abdominal aortic repair" and "prospective randomized trial"). RESULTS: Data on 30-day mortality and long-term survival are now available from four randomized multicenter trials. In three of these trials, endovascular treatment was found to lower 30-day mortality by two-thirds (endovascular: 0.2% to 1.7%, open repair: 0.7% to 4.7%), but this difference in survival was no longer present at two years. Compared to open open aortic surgery, endovascular treatment has a higher long-term complication rate. Endoleakage (perigraft leakage) accounted for more than 30% of complications and was the commonest reason for reintervention and unsuccessful intervention; in nearly all cases, it was successfully treated by the endovascular route. The rate of secondary aortic rupture was 0.8%, and migration of the prosthesis occurred in 5% of cases. Follow-up checks of the stent graft are now recommended at 3, 6 and 12 months after implantation, and annually thereafter. CONCLUSION: Prospective randomized trials have shown that the endovascular technique lowers perioperative mortality. In the long term, however, it has a higher complication rate than open aortic surgery and leads to more frequent reintervention.
Authors: F L Moll; J T Powell; G Fraedrich; F Verzini; S Haulon; M Waltham; J A van Herwaarden; P J E Holt; J W van Keulen; B Rantner; F J V Schlösser; F Setacci; J-B Ricco Journal: Eur J Vasc Endovasc Surg Date: 2011-01 Impact factor: 7.069
Authors: Jorg L De Bruin; Annette F Baas; Jaap Buth; Monique Prinssen; Eric L G Verhoeven; Philippe W M Cuypers; Marc R H M van Sambeek; Ron Balm; Diederick E Grobbee; Jan D Blankensteijn Journal: N Engl J Med Date: 2010-05-20 Impact factor: 91.245
Authors: Timur P Sarac; Connor Gibbons; Lina Vargas; Jane Liu; Sunita Srivastava; James Bena; Tara Mastracci; Vikram S Kashyap; Daniel Clair Journal: J Vasc Surg Date: 2011-11-03 Impact factor: 4.268
Authors: Dave Koole; Frans L Moll; Jacob Buth; Roel Hobo; Herman J A Zandvoort; Michiel L Bots; Gerard Pasterkamp; Joost A van Herwaarden Journal: J Vasc Surg Date: 2011-09-13 Impact factor: 4.268
Authors: Thom W Rooke; Alan T Hirsch; Sanjay Misra; Anton N Sidawy; Joshua A Beckman; Laura K Findeiss; Jafar Golzarian; Heather L Gornik; Jonathan L Halperin; Michael R Jaff; Gregory L Moneta; Jeffrey W Olin; James C Stanley; Christopher J White; John V White; R Eugene Zierler Journal: J Am Coll Cardiol Date: 2011-10-06 Impact factor: 24.094
Authors: Andres Schanzer; Roy K Greenberg; Nathanael Hevelone; William P Robinson; Mohammad H Eslami; Robert J Goldberg; Louis Messina Journal: Circulation Date: 2011-04-10 Impact factor: 29.690