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Short-term mortality benefit with EVAR not sustained
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Compared with open repair of abdominal aortic aneurysm, endovascular repair was associated with an improvement in 30-day mortality. However, this benefit did not persist during long-term follow-up.
According to researchers of a study published in Vascular, endovascular aneurysm repair (EVAR) has become increasingly popular since the 1990s and is now the preferred surgical intervention for more than 70% of elective abdominal aortic aneurysm (AAA) repairs performed in the United States.
To better understand the efficacy of the procedure, the researchers examined data on 632 patients with AAA treated with either EVAR (78.6%) or open aneurysm repair (OAR; 21.4%) from the Department of Defense health care system. The evaluated procedures occurred between 2006 and 2011.
Death, MI, stroke and cardiac arrhythmia served as the primary outcome measures, with a mean follow-up of 3.8 ± 1.9 years.
During the study, 109 patients died. At 30 days, mortality was reduced among patients who received EVAR compared with OAR (1.6% of patients vs. 6.7%; P = .004). This mortality reduction, however, did not persist during follow-up (EVAR, 16.9% vs. OAR, 17.8%; P = .797). Mean survival duration was comparable between the groups (EVAR, 6.14 ± 0.13 years vs. OAR, 6.11 ± 0.22 years; P = .378).
Similarly, there were no significant differences between the groups regarding the composite endpoint of the primary outcome measures at 30 days (EVAR, 12.9% vs. OAR, 14.1%) or longer-term follow-up (EVAR, 40.6% vs. OAR, 31.9%).
Individually, the two groups did not differ regarding 30-day incidence of MI, stroke or transient ischemic attack, cardiac arrhythmia, major or minor bleeding, bowel ischemia or need for reoperation. However, patients who underwent OAR experienced limb ischemia more frequently (4.5% vs. 0.8% of the EVAR group; P = .03). – by Brian Ellis
Disclosure: The researchers report no relevant financial disclosures.
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