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Endovascular abdominal aortic repair better than open repair for mortality
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In patients eligible for abdominal aortic repair, an endovascular approach was associated with lower mortality and shorter hospital stays when compared with an open repair approach.
Researchers enrolled 881 veterans who were eligible for elective endovascular abdominal aortic aneurysm repair and open repair. They then randomly assigned 444 of the patients to receive endovascular repair and 437 to receive open repair. The primary study outcome was all-cause mortality. The mean follow-up was 1.8 years.
Perioperative mortality was lower in the endovascular repair group vs. the open repair group at 30 days or hospitalization (0.5% vs. 3%, P=.004) and was higher for open repair at 30 days (2.3% vs. 0.2%, P=.006). There was no difference in two-year all-cause mortality between the treatment groups (7% vs. 9.8%, HR=0.7; 95% CI, 0.4-1.1). The researchers reported that patients in the endovascular repair group had reduced median procedure times (2.9 hours vs. 3.7 hours), reduced transfusion requirements (0 units vs. 1 unit) and shorter hospital stays (three days vs. seven days) but required higher exposure to fluoroscopy and contrast vs. the open repair group. No ruptures were reported in either group at two years.
“We confirmed that perioperative mortality is lower with endovascular repair than open repair and found no significant differences in postoperative morbidity or re-interventions,” Frank Lederle, MD, a professor of medicine at the University of Minnesota School of Medicine and director of the Minneapolis Veterans Affairs Center for Epidemiological and Clinical Research, said in a press briefing. “The difference between our study and earlier European studies are probably due to the later date and better overall results in the United States vs. Europe. We feel that the OVER study is the last, best hope for endovascular repair to fulfill its promise for improved survival.”
Cardiology Today reported the results of this study when they were presented at the 2009 Vascular Annual Meeting in Denver. – by Eric Raible
Lederle F. JAMA. 2009;302:1535-1542.