Endovascular or open repair for abdominal aortic aneurysm?BMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e8028 (Published 28 November 2012) Cite this as: BMJ 2012;345:e8028
Elective endovascular repair of abdominal aortic aneurysm is associated with lower perioperative mortality than open repair, and the survival advantage persisted for three years in the biggest and most recent head to head trial. By five years, however, there was no difference in all cause mortality between the two procedures, thanks to an excess of late deaths after endovascular repair (long term mortality 146 deaths/444 (32.9%) v 146/437 (33.4%); hazard ratio 0.97, 95% CI 0.77 to 1.22)⇑.
Few patients in either group died of their aneurysm, and endovascular repair remains a reasonable alternative to open surgery, say the authors. The two types of repair have similar long term mortality for patients who can choose. The participants in this US trial were almost exclusively white men who were current or ex-smokers. They had a mean age of 70 years when recruited, a high prevalence of smoking related cardiovascular and pulmonary disease, and aneurysms measuring a mean of 5.7 cm across. Endovascular repair looked a better option for younger patients in subgroup analyses.
These latest results are consistent with long term follow-up from two European trials, says a linked editorial (p 2041). Endovascular repair looks safer than open repair in the short and medium term, but mortality catches up later. It is not yet clear why, although the authors suspect that this pattern is the result of the frailest patients dying earlier after open repair and later after endovascular repair.
Cite this as: BMJ 2012;345:e8028