Endovascular repair of AAA

Endovascular repair of AAA

Endovascular repair of AAA (abdominal aortic aneurysm) is an evolving modality of treatment. Conventional repair of AAA was surgical. A study published in NEJM [1] compared endovascular repair with open surgical repair. This randomized study involved over 1200 patients from 1999 to 2004 in 37 hospitals in the United Kingdom. They were followed up till the end of 2009. Thirty day mortality was lower in the endovascular repair group (1.8%) compared to the open surgical repair group (4.3%). But the early mortality benefit was partially lost on follow up due to fatal endograft ruptures. There was no difference in all cause mortality between the two groups at the end of follow up. The study group concluded that endovascular repair was associated with graft related complications and re-interventions which were more costly. But this report is of patients who have undergone endovascular repair between 1999 and 2004. Technology has advanced much more since the earlier procedures in this group and this disadvantage is there for any study of long duration. By the time study is completed, the report will be that of an older technology, the results of which may not be equivalent to that of the current technology.

Another study published in the same issue of the journal also made similar conclusions.

Reference

  1. United Kingdom EVAR Trial Investigators; Roger M Greenhalgh, Louise C Brown, Janet T Powell, Simon G Thompson, David Epstein, Mark J Sculpher. Endovascular versus open repair of abdominal aortic aneurysm. N Engl J Med. 2010 May 20;362(20):1863-71.