Endovascular vs Open Repair of Abdominal Aortic Aneurysms in the Medicare Population
Schermerhorn ML, O'Malley J, Jhaveri A, Cotterill P; Pomposelli F; Landon BE
N Engl J Med. 2008;358:464-474
Summary
How does endovascular repair (EVAR) of abdominal aneurysms compare with conventional open repair? The authors reviewed results from 22,830 Medicare patients (average age, 74 years) followed for up to 4 years after they had received either endovascular or open procedures. Early mortality was much lower after endovascular repair: 1.2% vs 4.8%, P < .001). During the follow-up period, the EVAR group had a higher frequency of rupture (1.8% vs 0.5%) and more patients required additional surgery for the graft than those who had the open procedure. However, patients treated with an open repair had more complications related to the abdominal surgery, such as bowel obstruction or abdominal wall hernia, than those who had EVAR. By 4 years, the overall survival in the 2 groups, which initially favored the endovascular group, was identical.
Viewpoint
EVAR for abdominal aortic aneurysms now accounts for about 40% of all of these repair operations. This study, with results extending over a 4-year period, shows an initial overall survival benefit for endovascular repair, which disappears at 4 years. This was not a true randomized study, but the authors attempted to match the 2 groups on factors such as age, sex, race, and coexisting conditions. The results apply only to persons 65 years of age and older; findings might be different in younger patients, with a better survival outlook and an anticipated longer life span. As experience accumulates, the results following EVAR might be expected to improve.
Reviewed By Ramaz Mitaishvili, MD
