Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial

@article{Greenhalgh2004ComparisonOE,
  title={Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial},
  author={R M Greenhalgh},
  journal={The Lancet},
  year={2004},
  volume={364},
  pages={843-848}
}
BACKGROUND Endovascular aneurysm repair (EVAR) is a new technology to treat patients with abdominal aortic aneurysm (AAA) when the anatomy is suitable. [...] Key Method Patients aged at least 60 years with aneurysms of diameter 5.5 cm or more, who were fit enough for open surgical repair (anaesthetically and medically well enough for the procedure), were recruited for the study at 41 British hospitals proficient in the EVAR technique.Expand

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TLDR
Compared with open repair, EVAR offers no advantage with respect to all-cause mortality and HRQL, is more expensive, and leads to a greater number of complications and reinterventions, however, it does result in a 3% better aneurysm-related survival. Expand
Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): randomised controlled trial
TLDR
Compared with open repair, EVAR offers no advantage with respect to all-cause mortality and HRQL, is more expensive, and leads to a greater number of complications and reinterventions, however, it does result in a 3% better aneurysm-related survival. Expand
Endovascular aneurysm repair and outcome in patients unfit for open repair of abdominal aortic aneurysm (EVAR trial 2): randomised controlled trial
TLDR
EVAR did not improve survival over no intervention and was associated with a need for continued surveillance and reinterventions, at substantially increased cost. Expand
Endovascular aneurysm repair and outcome in patients unfit for open repair of abdominal aortic aneurysm (EVAR trial 2): randomised controlled trial
TLDR
EVAR did not improve survival over no intervention and was associated with a need for continued surveillance and reinterventions, at substantially increased cost. Expand
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Despite the relative high operative mortality in the EVAR group, these preliminary results show that it is possible to recruit patients to a randomised trial of OAR and EVAR in patients with ruptured AAA. Expand
Endovascular versus open repair of abdominal aortic aneurysm in 15-years' follow-up of the UK endovascular aneurysm repair trial 1 (EVAR trial 1): a randomised controlled trial
TLDR
EVAR has an early survival benefit but an inferior late survival compared with open repair, which needs to be addressed by lifelong surveillance of EVAR and re-intervention if necessary. Expand
Endovascular repair of abdominal aortic aneurysm does not improve early survival versus open repair in patients younger than 60 years.
  • P. Gupta, B. Ramanan, +7 authors I. I. Pipinos
  • Medicine
  • European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery
  • 2012
TLDR
30-day mortality rate after open repair is similar to that after EVAR in patients younger than 60 years with infrarenal AAA, demonstrating that the mortality advantage for EVAR is being lost within 2 years of repair. Expand
Endovascular aortic aneurysm repair (EVAR) has significantly lower perioperative mortality in comparison to open repair: a systematic review.
TLDR
EVAR carries a threefold lower risk of perioperative death in comparison to open repair of abdominal aortic aneurysm, which must be offset against the increased need for later re-intervention and probable equivalence of long-term outcome. Expand
Strategy of endovascular versus open repair for patients with clinical diagnosis of ruptured abdominal aortic aneurysm: the IMPROVE RCT.
TLDR
A randomised controlled trial to assess whether or not a strategy of endovascular repair compared with open repair reduces 30-day and mid-term mortality and cost-effectiveness among patients with a suspected ruptured AAA. Expand
Elective treatment of abdominal aortic aneurysm with endovascular or open repair: the first decade.
TLDR
Open repair and EVAR are both performed safely in patients treated for elective infrarenal AAA, with EVAR having the perioperative advantages of reduced blood loss, reduced length of intensive care unit and hospital stay, and increased number of patients discharged to home. Expand
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Endovascular repair results in less blood loss, shorter intensive care unit and hospital stays, lower 30-day mortality, and lower systemic and/or remote complication rates than those of open surgical repair. Expand
The UK Endovascular Aneurysm Repair (EVAR) trials: design, methodology and progress.
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OBJECTIVES to assess the early morbidity and mortality of a new treatment, the endovascular repair of abdominal aortic aneurysms, during its introduction into clinical practice. DESIGN aExpand
IMMEDIATE REPAIR COMPARED WITH SURVEILLANCE OF SMALL ABDOMINAL AORTIC ANEURYSMS
TLDR
The rate of death from any cause, the primary outcome, was not significantly different in the two groups (relative risk in the immediate-repair group as compared with the surveillance group), and the rate of repair had been performed in 92.6 percent of the patients in the immediately- Repair group and 61.6% of those in the Surveillance group. Expand
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The results do not support a policy of open surgical repair for abdominal aortic aneurysms of 4.0-5.5 cm in diameter, and early surgery does not provide a long-term survival advantage. Expand
Incidence and risk factors of late rupture, conversion, and death after endovascular repair of infrarenal aortic aneurysms: The EUROSTAR experience
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Endovascular repair of infrarenal aortic aneurysms with the first- and second-generation devices that predominated in this study was associated with a risk of late failure, according to an analysis of observed hard end points of 3% per year. Expand
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TLDR
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It is suggested that endovascular AAA repairs are being performed in a patient population with a higher frequency of comorbidities, and early perioperative outcomes may be superior to those with conventional open repair. Expand
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The DREAM-trial will lead to a safe and controlled introduction of a new technology, the medical community will obtain valid scientific evidence of the merits of endovascular AAA repair, and policy makers will be provided with accurate cost-effectiveness data for the Dutch healthcare system. Expand
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