IMPROVE Study Compares EVAR-First Strategy Versus Open Repair for Ruptured AAAs

April 16, 2015—One-year outcomes in the IMPROVE trial were published by Richard Grieve, MD, et al online ahead of print in the European Heart Journal. The aim of this study was to report the longer-term outcomes following either a strategy of endovascular repair (EVAR) first or open repair of ruptured abdominal aortic aneurysms (rAAAs). 

The investigators concluded that an EVAR-first strategy for management of rAAAs does not offer a survival benefit over surgery at 1 year but offers patients faster discharge with better quality of life and is cost-effective.

As summarized in the European Heart Journal, this pragmatic multicenter trial was conducted at 29 centers in the United Kingdom and one center in Canada. The trial was composed of 613 patients with a clinical diagnosis of rAAAs who were randomized to an EVAR-first strategy (if aortic morphology was suitable, open repair if not; n = 316) and to open repair (n = 297). The principal 1-year outcome was mortality. Secondary outcomes were reinterventions, hospital discharge, health-related quality-of-life (EQ-5D), costs, quality-adjusted-life-years, and cost-effectiveness [incremental net benefit (INB)]. 

The investigators found that at 1 year, all-cause mortality was 41.1% for the EVAR-first strategy group and 45.1% for the open repair group, with similar reintervention rates in each group. The EVAR strategy group and open repair groups had average total hospital stays of 17 and 26 days, respectively. Patients surviving rupture had higher average EQ-5D utility scores in the EVAR strategy versus open repair groups at 3 and 12 months, respectively. There were indications that quality-adjusted-life-years were higher and costs lower for the EVAR-first strategy, combining to give an INB of £3,877 or €4,356, reported the investigators in the European Heart Journal.

For more on the topic of ruptured AAA treatment, be sure to see the March edition of Endovascular Today, which focused on rEVAR. Included in this feature is a lively debate on current data featuring IMPROVE investigators Janet Powell, MD, PhD, FRCPath, and Robert J. Hinchliffe, MD, FRCS, versus Frank Veith, MD, and Caron B. Rockman, MD.