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A Randomized Trial Comparing Conventional and Endovascular Repair of Abdominal Aortic Aneurysms

A Randomized Trial Comparing Conventional and Endovascular Repair of Abdominal Aortic Aneurysms,Monique Prinssen,Eric L. G. Verhoeven,Jaap Buth,Philip

A Randomized Trial Comparing Conventional and Endovascular Repair of Abdominal Aortic Aneurysms   (Citations: 64)
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background Although the initial results of endovascular repair of abdominal aortic aneurysms were promising, current evidence from controlled studies does not convincingly show a re- duction in 30-day mortality relative to that achieved with open repair. methods We conducted a multicenter, randomized trial comparing open repair with endovascu- lar repair in 345 patients who had received a diagnosis of abdominal aortic aneurysm of at least 5 cm in diameter and who were considered suitable candidates for both tech- niques. The outcome events analyzed were operative (30-day) mortality and two com- posite end points of operative mortality and severe complications and operative mor- tality and moderate or severe complications. results The operative mortality rate was 4.6 percent in the open-repair group (8 of 174 pa- tients; 95 percent confidence interval, 2.0 to 8.9 percent) and 1.2 percent in the endo- vascular-repair group (2 of 171 patients; 95 percent confidence interval, 0.1 to 4.2 per- cent), resulting in a risk ratio of 3.9 (95 percent confidence interval, 0.9 to 32.9). The combined rate of operative mortality and severe complications was 9.8 percent in the open-repair group (17 of 174 patients; 95 percent confidence interval, 5.8 to 15.2 per- cent) and 4.7 percent in the endovascular-repair group (8 of 171 patients; 95 percent confidence interval, 2.0 to 9.0 percent), resulting in a risk ratio of 2.1 (95 percent con- fidence interval, 0.9 to 5.4). conclusions On the basis of the overall results of this trial, endovascular repair is preferable to open repair in patients who have an abdominal aortic aneurysm that is at least 5 cm in diam- eter. Long-term follow-up is needed to determine whether this advantage is sustained.
Published in 2010.
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    • ...In contrast, in randomised trials, the elective repair of large aneurysms by open repair or endovascular stenting had a 30 day mortality of 4.6% and 1.2%, respectively....

    David Metcalfeet al. The management of abdominal aortic aneurysms

    • ...The appraisal committee first considered the evidence on the clinical effectiveness of EVAR for the treatment of unruptured infra-renal abdominal aortic aneurysms. Four randomised controlled trials (RCTs) were identified ...

    N Hayet al. Endovascular stent-grafts for the treatment of abdominal aortic aneury...

    • ...The EVAR 1 and DREAM trials were conducted in carefully selected patients with optimal anatomy. There is no question that the results show a clear, significant mortality benefit at 30 days in patients treated by endovascular repair. EVAR confers a 30-day mortality of 1.7% and 1.2% as reported in both the EVAR 1 and DREAM trials, respectively. ...

    M Daviset al. Endovascular infrarenal abdominal aortic aneurysm repair

    • ...Technical success was achieved in 97.9% of patients. Patients treated with this device had significantly decreased perioperative mortality, blood loss, operative time, ICU and hospital stay compared to the open control group. There were no reported type I, III or IV endoleaks at the 48-month follow-up, nor were there any ruptures, graft fabric defects or wire fractures. Aneurysm sac regression was noted in 83% of patients. The authors concluded that the PowerLink device is safe and protects treated patients from rupture, with longer follow-up needed to determine the durability of such repairs.Randomized Trials of Open versus Endovascular AAA RepairThe DREAM TrialThis was a multicenter, randomized trial comparing open with endovascular repair in 351 patients with an AAA of at least 5 cm in diameter who were considered suitable candidates for both techniques. The 30-day outcomes showed that the operative mortality rate was 4.6% in the open repair group and 1.2% in the endovascular repair group [...

    Rabih A. Chaeret al. Endovascular Treatment of Aortic Aneurysms: Techniques and Clinical Up...

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