Outcomes Following Endovascular vs Open Repair of Abdominal Aortic Aneurysm: A Randomized Trial

CONTEXT Limited data are available to assess whether endovascular repair of abdominal aortic aneurysm (AAA) improves short-term outcomes compared with traditional open repair. OBJECTIVE To compare postoperative outcomes up to 2 years after endovascular or open repair of AAA in a planned interim repo...

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Published in:	JAMA : the journal of the American Medical Association 2009-10, Vol.302 (14), p.1535-1542
Main Authors:	Lederle, Frank A, Freischlag, Julie A, Kyriakides, Tassos C, Padberg, Frank T, Matsumura, Jon S, Kohler, Ted R, Lin, Peter H, Jean-Claude, Jessie M, Cikrit, Dolores F, Swanson, Kathleen M, Peduzzi, Peter N, Open Versus Endovascular Repair (OVER) Veterans Affairs Cooperative Study Group, for the
Format:	Article
Language:	eng
Subjects:	Aged Aneurysms Aortic Aneurysm, Abdominal - mortality Aortic Aneurysm, Abdominal - surgery Biological and medical sciences Blood Vessel Prosthesis Implantation - methods Blood Vessel Prosthesis Implantation - mortality Catheterization, Peripheral Clinical trials Erectile Dysfunction - epidemiology Female General aspects Humans Kaplan-Meier Estimate Length of Stay Male Medical sciences Middle Aged Minimally Invasive Surgical Procedures Morbidity Mortality Postoperative Complications - epidemiology Proportional Hazards Models Quality of Life
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Summary:	CONTEXT Limited data are available to assess whether endovascular repair of abdominal aortic aneurysm (AAA) improves short-term outcomes compared with traditional open repair. OBJECTIVE To compare postoperative outcomes up to 2 years after endovascular or open repair of AAA in a planned interim report of a 9-year trial. DESIGN, SETTING, AND PATIENTS A randomized, multicenter clinical trial of 881 veterans (aged ≥49 years) from 42 Veterans Affairs Medical Centers with eligible AAA who were candidates for both elective endovascular repair and open repair of AAA. The trial is ongoing and this report describes the period between October 15, 2002, and October 15, 2008. INTERVENTION Elective endovascular (n = 444) or open (n = 437) repair of AAA. MAIN OUTCOME MEASURES Procedure failure, secondary therapeutic procedures, length of stay, quality of life, erectile dysfunction, major morbidity, and mortality. RESULTS Mean follow-up was 1.8 years. Perioperative mortality (30 days or inpatient) was lower for endovascular repair (0.5% vs 3.0%; P = .004), but there was no significant difference in mortality at 2 years (7.0% vs 9.8%, P = .13). Patients in the endovascular repair group had reduced median procedure time (2.9 vs 3.7 hours), blood loss (200 vs 1000 mL), transfusion requirement (0 vs 1.0 units), duration of mechanical ventilation (3.6 vs 5.0 hours), hospital stay (3 vs 7 days), and intensive care unit stay (1 vs 4 days), but required substantial exposure to fluoroscopy and contrast. There were no differences between the 2 groups in major morbidity, procedure failure, secondary therapeutic procedures, aneurysm-related hospitalizations, health-related quality of life, or erectile function. CONCLUSIONS In this report of short-term outcomes after elective AAA repair, perioperative mortality was low for both procedures and lower for endovascular than open repair. The early advantage of endovascular repair was not offset by increased morbidity or mortality in the first 2 years after repair. Longer-term outcome data are needed to fully assess the relative merits of the 2 procedures. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00094575
ISSN:	0098-7484 1538-3598