Long-Term Survival Similar for Endovascular, Open AAA Repair

For patients with asymptomatic abdominal aortic aneurysm, long-term overall survival is similar with either endovascular repair or open repair, according to a study published in the May 30 issue of the New England Journal of Medicine.

Frank A. Lederle, M.D., from the Veterans Affairs Medical Center in Minneapolis, and colleagues randomly assigned patients with asymptomatic abdominal aortic aneurysm to endovascular repair (444 patients) or open repair (437 patients). Patients were followed for up to 14 years for a primary outcome of all-cause mortality.

The researchers found that 68.0 and 70.0 percent of patients in the endovascular-repair and open-repair groups died (hazard ratio, 0.96; 95 percent confidence interval, 0.82 to 1.13). Overall survival seemed to be higher with endovascular repair during the first four years of follow-up compared with open repair; from year 4 through 8, the open-repair group had higher overall survival. After eight years, overall survival was higher in the endovascular-repair group (hazard ratio for death, 0.94; 95 percent confidence interval, 0.74 to 1.18). These trends were not significant. Aneurysm-related deaths occurred in 2.7 and 3.7 percent of the endovascular- and open-repair groups, respectively (between-group difference, −1.0 percentage points; 95 percent confidence interval, −3.3 to 1.4); most deaths occurred during the perioperative period.

"The operative mortality in our trial was lower than that currently reported nationally in the United States," the authors write. "This suggests that our results can have ongoing relevance."

Two authors disclosed financial ties to the pharmaceutical industry.

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