• DOI:10.1056/NEJMOA042002
• Corpus ID: 21350195

A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms.

@article{Prinssen2004ART,
  title={A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms.},
  author={Monique Prinssen and Eric L.G. Verhoeven and J. Buth and Philippe W. M. Cuypers and Marc R.H.M. van Sambeek and Ron Balm and Erik Buskens and Diederick E. Grobbee and Jan D. Blankensteijn},
  journal={The New England journal of medicine},
  year={2004},
  volume={351 16},
  pages={
          1607-18
        }
}

• M. Prinssen, E. Verhoeven, +6 authors J. Blankensteijn
• Published 14 October 2004
• Medicine
• The New England journal of medicine

BACKGROUND
Although the initial results of endovascular repair of abdominal aortic aneurysms were promising, current evidence from controlled studies does not convincingly show a reduction in 30-day mortality relative to that achieved with open repair.

METHODS
We conducted a multicenter, randomized trial comparing open repair with endovascular 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 techniques. The outcome events analyzed were operative (30-day) mortality and two composite end points of operative mortality and severe complications and operative mortality and moderate or severe complications.

RESULTS
The operative mortality rate was 4.6 percent in the open-repair group (8 of 174 patients; 95 percent confidence interval, 2.0 to 8.9 percent) and 1.2 percent in the endovascular-repair group (2 of 171 patients; 95 percent confidence interval, 0.1 to 4.2 percent), 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 percent) 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 confidence 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 diameter. Long-term follow-up is needed to determine whether this advantage is sustained.