Twelve-Year Data Reported From DREAM Trial Comparing EVAR and Open Repair of AAAs
October 25, 2017—Theodorus G. van Schaik, MD, et al published findings updating the results of the Dutch Randomized Endovascular Aneurysm Management (DREAM) trial in Journal of Vascular Surgery (JVS; 2017;66:1379–1389).
As summarized in JVS, DREAM is a multicenter, randomized controlled trial comparing open with endovascular aneurysm repair with up to 15 years of follow-up. There were 178 patients randomized to open repair and 173 to endovascular repair.
Survival and reinterventions were analyzed on an intention-to-treat basis. Causes of death and secondary interventions were compared using an events per person-year analysis.
The investigators reported that at 12 years after randomization, the cumulative overall survival rates were 42.2% for open and 38.5% for endovascular repair, for a difference of 3.7 percentage points (95% confidence interval [CI], -6.7 to 14.1; P = .48).
The cumulative rates of freedom from reintervention were 78.9% for open repair and 62.2% for endovascular repair, for a difference of 16.7 percentage points (95% CI, 5.8 to 27.6; P = .01). No differences were observed in causes of death. Cardiovascular and malignant disease account for the majority of deaths after prolonged follow-up.
The investigators concluded that during 12 years of follow-up, there was no survival difference between patients who underwent open or endovascular abdominal aortic aneurysm repair, despite a continuously increasing number of reinterventions in the endovascular repair group. Endograft durability and the need for continued endograft surveillance remain key issues, advised the investigators in JVS.