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Long-Term Survival Comparable Between Endovascular, Open AAA Repair
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Despite a perioperative survival advantage with endovascular abdominal aortic aneurysm repair compared with open repair, long-term survival was similar between the procedures, according to results published in The New England Journal of Medicine.
“Our results suggest that endovascular repair continues to improve and is now an acceptable alternative to open repair even when judged in terms of long-term survival. However, our results also indicate that late rupture remains a concern and that endovascular repair does not yet offer a long-term advantage over open repair, particularly among older patients, for whom such an advantage was originally expected,” Frank A. Lederle, MD, and fellow investigators from the OVER study group, wrote.
In the multicenter, randomized trial, Lederle and colleagues randomly assigned 881 patients with asymptomatic abdominal aortic aneurysm (AAA) to receive endovascular (n=444) or open (n=437) repair. Patients were selected from 42 Veterans Affairs medical centers, were 49 years of age or older at the time of registration (mean age, 70 years) and were followed for up to 9 years (mean, 5.2 years).
Frank A. Lederle
The primary outcome, defined as all-cause mortality, occurred in 146 patients in each group (HR with endovascular repair=0.97; 95% CI, 0.77-1.22). Lower perioperative mortality with endovascular repair was observed at 2 years (HR=0.63; 95% CI, 0.40-0.98) and 3 years (HR=0.72; 95% CI, 0.51-1.00). However, after 3 years, there was no significant survival advantage with either strategy.
When broken down by age, patients who were younger than 70 years fared better with endovascular repair (HR=0.65; 95% CI, 0.43-0.98), whereas patients aged 70 years or older did better with open repair (HR for endovascular repair=1.31; 95% CI, 0.99-1.73), an interaction that reached statistical significance (P=.006).
In all, there were 10 aneurysm-related deaths in the endovascular-repair group (2.3%) compared with 16 in the open-repair group (3.7%; P=.22) and six aneurysm ruptures in the endovascular-repair group vs. none in the open-repair group (P=.03).