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Open, endovascular repair of AAA similar at 12-year follow-up
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In patients with infrarenal abdominal aortic aneurysms, there was little difference in overall survival between open and endovascular repair at 12 years, despite a continuously increasing number of secondary procedures after endovascular repair, according to results published in the Journal of Vascular Surgery.
“We hypothesized that longer follow-up of the randomized trials would be required to demonstrate the cumulative negative impact on overall survival from secondary procedures after endovascular abdominal aortic aneurysm repair. This study could not demonstrate such an effect,” Theodorus G. van Schaik, MD, from the division of vascular surgery and department of surgery at VU Medical Center in Amsterdam, and colleagues wrote. “The impact of the continuously increasing number of reinterventions, the durability issues of endovascular grafts, and the cumulative irradiation effects of the increased use of CT for endograft surveillance did not accumulate to a significant survival disadvantage after endovascular repair.”
Van Schaik and colleagues updated the randomized, multicenter DREAM trial, which compared open repair with EVAR to analyze survival and reinterventions in 351 patients on an intention-to-treat basis. Additionally, the researchers compared causes of death and secondary interventions using an events per person-year analysis.
Primary outcomes of the study were death from all causes, aneurysm-related mortality and secondary procedures.
Of the 351 patients included in the study, 178 were randomly assigned to open repair and 173 to EVAR between November 2000 and December 2003.
Cumulative survival rates 12 years after randomization were 42.2% for open repair and 38.5% for EVAR (3.7 percentage-point difference; 95% CI, 6.7 to 14.1; P = .48).
Freedom from intervention was 78.9% for open repair and 62.2% for EVAR (16.7 percentage-point difference; 95% CI, 5.8-27.6; P = .01).
The researchers found no differences between the two groups for causes of death.
Most of the deaths in the long-term follow-up were caused by CVD or malignant disease.
Due to concerns of durability of EVAR, longer-term follow-up may be required to demonstrate the cumulative negative impact on survival of higher reintervention rates linked to EVAR, van Schaik and colleagues wrote.
“This calls for continued vigilant endograft surveillance extending well into the second decade after aneurysm repair, using follow-up protocols with the least possible amount of ionizing radiation, and for a renewed awareness that endograft durability is of utmost importance in future device design,” the researchers concluded. by Dave Quaile
Disclosures: The DREAM trial was funded by a grant from The Netherlands National Health Insurance Council. Van Schaik reports no relevant financial disclosures. Please see the study for all other authors’ financial disclosures.
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