Peri-op survival advantage for endovascular repair sustained for three years, but not after
THURSDAY, Nov. 22 (HealthDay News) -- For repair of abdominal aortic aneurysms, endovascular repair and open repair result in similar long-term survival, according to a study published in the Nov. 22 issue of the New England Journal of Medicine.
Frank A. Lederle, M.D., from the Veterans Affairs Medical Centers in Minneapolis, and colleagues randomly assigned 881 patients (49 years or older) with asymptomatic abdominal aortic aneurysms to either endovascular repair (444 patients) or open repair (437 patients) and followed them for a mean of 5.2 years.
The researchers found that 146 deaths occurred in each group. There was a significant reduction in perioperative mortality with endovascular repair at two years (hazard ratio [HR], 0.63; P = 0.04) and at three years (HR, 0.72; P = 0.05), but not thereafter. In the endovascular-repair group there were 10 aneurysm-related deaths, compared to 16 in the open-repair group (2.3 versus 3.7 percent; P = 0.22). In the endovascular-repair group there were six confirmed aneurysm ruptures versus none in the open-repair group (P = 0.03). In the endovascular-repair group, survival was significantly increased among patients under 70 years of age, while for patients age 70 years or older, survival tended to be better for those in the open-repair group.
"Our results suggest that endovascular repair continues to improve and is now an acceptable alternative to open repair even when judged in terms of long-term survival," the authors write.
Full Text (subscription or payment may be required) (http://www.nejm.org/doi/full/10.1056/NEJMoa1207481?query=featured_home )Editorial (subscription or payment may be required) (http://www.nejm.org/doi/full/10.1056/NEJMe1211163?query=featured_home )