EVAR and OAR Outcomes Compared for AAA Therapy

October 14, 2009—In the Journal of the American Medical Association, Frank A. Lederle, MD, et al published findings from a study that sought to compare postoperative outcomes up to 2 years after endovascular (EVAR) or open repair (OAR) of abdominal aortic aneurysms (AAAs) in a planned interim report of a 9-year trial (2009;302:1535–1542).

According to the investigators, limited data are available to assess whether EVAR for AAA improves short-term outcomes compared with traditional OAR. This study was a randomized, multicenter clinical trial of 881 veterans (aged 49 years) from 42 Veterans Affairs medical centers with eligible AAAs who were candidates for both elective EVAR and OAR of AAAs. The trial is ongoing, and this report describes the period between October 15, 2002, and October 15, 2008. In the study, patients were randomized to elective EVAR (n = 444) or OAR (n = 437) for AAAs. The main outcome measures were procedure failure, secondary therapeutic procedures, length of stay, quality of life, erectile dysfunction, major morbidity, and mortality. Mean follow-up was 1.8 years.

The investigators reported that perioperative mortality (30 days or inpatient) was lower for EVAR (0.5% vs 3%; P = .004), but there was no significant difference in mortality at 2 years (7% vs 9.8%; P = .13). Patients in the EVAR group had reduced median procedure time (2.9 vs 3.7 hours), blood loss (200 vs 1,000 mL), transfusion requirement (0 vs 1 unit), duration of mechanical ventilation (3.6 vs 5 hours), hospital stay (3 vs 7 days), and intensive care unit stay (1 vs 4 days) but required substantial exposure to fluoroscopy and contrast. There were no differences between the two groups in major morbidity, procedure failure, secondary therapeutic procedures, aneurysm-related hospitalizations, health-related quality of life, or erectile function.

The investigators concluded that in this report of short-term outcomes after elective AAA repair, perioperative mortality was low for both procedures and lower for EVAR than OAR. The early advantage of EVAR was not offset by increased morbidity or mortality in the first 2 years after repair. Longer-term outcome data are needed to fully assess the relative merits of the two procedures.