French ECAR Study Compares Endovascular and Open Repair for Ruptured Aortoiliac Aneurysms

August 25, 2015—Findings from ECAR (Endovasculaire ou Chirurgie dans les Anévrysmes aorto-iliaques Rompus), a French randomized controlled trial of endovascular aortic repair (EVAR) versus open surgical repair (OSR) of ruptured aortoiliac aneurysms, were published by Prof. Pascal Desgranges, MD, et al in the European Journal of Vascular and Endovascular Surgery (EJVES, 2015; 50:303–310).

The ECAR investigators found that EVAR was equal to OSR in terms of 30-day and 1-year mortality, and EVAR was associated with less severe complications and less consumption of hospital resources than OSR.

As summarized in EJVES, ECAR is a prospective multicenter randomized controlled trial including consecutive patients with ruptured aortoiliac aneurysms eligible for treatment by either EVAR or OSR. Inclusion criteria were hemodynamic stability and computed tomography scan demonstrating aortoiliac rupture. Randomization was done simultaneously by week in all centers.

The ECAR study’s primary endpoint was 30-day mortality, and secondary endpoints were postoperative morbidity, length of stay in the intensive care unit (ICU), amount of blood transfused (units), and 6-month mortality.

The investigators enrolled 107 patients (97 men, 10 women; median age 74.4 years) in 14 centers from January 2008 to January 2013. Patients were randomized to EVAR (n = 56; 52.3%) and to OSR (n = 51; 47.7%). The groups were similar in terms of age, sex, consciousness, systolic blood pressure, Hardman index, IGSII score, type of rupture, use of endoclamping balloon, and levels of troponin, creatinine, and hemoglobin. Delay to treatment was higher in the EVAR group than the OSR group (2.9 vs 1.3 hours).

The ECAR investigators in EJVES reported that the EVAR group and OSR group had mortality rates of 18% versus 24% at 30 days, and 30% versus 35% at 1 year. Total respiratory support time was lower in the EVAR group than in the OSR group (59.3 hours vs 180.3 hours), as was the rate of pulmonary complications (15.4% vs 41.5%), number of total blood transfusions (6.8 vs 10.9), and duration of ICU stay (7 days vs 11.9 days).