A randomized controlled trial of endovascular aneurysm repair versus open surgery for abdominal aortic aneurysms in low- to moderate-risk patients

Background Several studies, including three randomized controlled trials (RCTs), have shown that endovascular repair (EVAR) of abdominal aortic aneurysms (AAA) offered better early results than open surgical repair (OSR) but a similar medium-term to long-term mortality and a higher incidence of rein...

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Published in:Journal of vascular surgery 2011-05, Vol.53 (5), p.1167-1173.e1
Main Authors: Becquemin, Jean-Pierre, MD, Pillet, Jean-Chistophe, MD, Lescalie, François, MD, Sapoval, Marc, MD, Goueffic, Yann, MD, Lermusiaux, Patrick, MD, Steinmetz, Eric, MD, Marzelle, Jean, MD
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal
Aortic Aneurysm, Abdominal - diagnostic imaging
Aortic Aneurysm, Abdominal - mortality
Aortic Aneurysm, Abdominal - surgery
Aortography
Aortography - methods
Biological and medical sciences
Blood and lymphatic vessels
Blood Vessel Prosthesis Implantation
Blood Vessel Prosthesis Implantation - adverse effects
Blood Vessel Prosthesis Implantation - mortality
Cardiology. Vascular system
Chi-Square Distribution
Disease-Free Survival
Diseases of the aorta
Endovascular Procedures
Endovascular Procedures - adverse effects
Endovascular Procedures - mortality
Female
France
Hospital Mortality
Humans
Kaplan-Meier Estimate
Life Sciences
Male
Medical sciences
Middle Aged
Prospective Studies
Reoperation
Risk Assessment
Risk Factors
Surgery
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Survival Rate
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels
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Summary:Background Several studies, including three randomized controlled trials (RCTs), have shown that endovascular repair (EVAR) of abdominal aortic aneurysms (AAA) offered better early results than open surgical repair (OSR) but a similar medium-term to long-term mortality and a higher incidence of reinterventions. Thus, the role of EVAR, most notably in low-risk patients, remains debated. Methods The ACE (Anevrysme de l'aorte abdominale: Chirurgie versus Endoprothese) trial compared mortality and major adverse events after EVAR and OSR in patients with AAA anatomically suitable for EVAR and at low-risk or intermediate-risk for open surgery. A total of 316 patients with >5 cm aneurysms were randomized in institutions with proven expertise for both treatments: 299 patients were available for analysis, and 149 were assigned to OSR and 150 to EVAR. Patients were monitored for 5 years after treatment. Statistical analysis was by intention to treat. Results With a median follow-up of 3 years (range, 0-4.8 years), there was no difference in the cumulative survival free of death or major events rates between OSR and EVAR: 95.9% ± 1.6% vs 93.2% ± 2.1% at 1 year and 85.1% ± 4.5% vs 82.4% ± 3.7% at 3 years, respectively ( P = .09). In-hospital mortality (0.6% vs 1.3%; P = 1.0), survival, and the percentage of minor complications were not statistically different. In the EVAR group, however, the crude percentage of reintervention was higher (2.4% vs 16%, P < .0001), with a trend toward a higher aneurysm-related mortality (0.7% vs 4%; P = .12). Conclusions In patients with low to intermediate risk factors, open repair of AAA is as safe as EVAR and remains a more durable option.
ISSN:0741-5214
1097-6809
DOI:10.1016/j.jvs.2010.10.124